Healthcare Provider Details

I. General information

NPI: 1942528104
Provider Name (Legal Business Name): AMY NELSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY FLETCHER

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 STE 100
INDIAN WELLS CA
92210-7129
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-8989
  • Fax:
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9281600
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9281600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: