Healthcare Provider Details

I. General information

NPI: 1174385751
Provider Name (Legal Business Name): AMANDA MARIA PEREZ AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIA SEBASTIAO AGACNP

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CAMPUS DR
SCARBOROUGH ME
04074-7163
US

IV. Provider business mailing address

96 CAMPUS DR
SCARBOROUGH ME
04074-7163
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-9905
  • Fax: 207-396-5600
Mailing address:
  • Phone: 207-885-9905
  • Fax: 207-396-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP231613
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: