Healthcare Provider Details

I. General information

NPI: 1659303162
Provider Name (Legal Business Name): CECILIA A AMANTI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 29TH ST
TUCSON AZ
85713-3353
US

IV. Provider business mailing address

6408 E TANQUE VERDE RD
TUCSON AZ
85715-3809
US

V. Phone/Fax

Practice location:
  • Phone: 520-884-9920
  • Fax:
Mailing address:
  • Phone: 520-885-5558
  • Fax: 520-885-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN054535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: