Healthcare Provider Details

I. General information

NPI: 1235835570
Provider Name (Legal Business Name): AMY VARGAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PAR DR
JESUP GA
31546-2119
US

IV. Provider business mailing address

6 PAR DR
JESUP GA
31546-2119
US

V. Phone/Fax

Practice location:
  • Phone: 912-294-0805
  • Fax:
Mailing address:
  • Phone: 912-294-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024247
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP293183
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP293183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: