Healthcare Provider Details

I. General information

NPI: 1386925931
Provider Name (Legal Business Name): AMY TUDOR GARLAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PLEASANT STREET - STE 202 PRIMA CARE, PC
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

277 PLEASANT STREET 4TH FLOOR PRIMA CARE, PC
FALL RIVER MA
02721-3005
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3292
  • Fax:
Mailing address:
  • Phone: 508-676-3292
  • Fax: 508-672-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305861-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340826-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2297416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: