Healthcare Provider Details

I. General information

NPI: 1790229110
Provider Name (Legal Business Name): AMY FORD MSN, WHNP-BC, CNM-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 23RD ST STE 220
MIAMI BEACH FL
33139-1700
US

IV. Provider business mailing address

42 VIA VERONA
PALM BEACH GARDENS FL
33418-3746
US

V. Phone/Fax

Practice location:
  • Phone: 917-426-2223
  • Fax: 833-992-2457
Mailing address:
  • Phone: 208-651-6311
  • Fax: 833-992-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01295600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP000625
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number025256
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10548
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11000981
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11000981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: