Healthcare Provider Details

I. General information

NPI: 1528980430
Provider Name (Legal Business Name): AMANDA CORINE ANDERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MILL AVE
TEMPE AZ
85281-6699
US

IV. Provider business mailing address

12809 W SELLS DR
LITCHFIELD PARK AZ
85340-6522
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-5500
  • Fax:
Mailing address:
  • Phone: 678-789-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number238669
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number238669
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number238669
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number238669
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: