Healthcare Provider Details

I. General information

NPI: 1508687559
Provider Name (Legal Business Name): AMY PETERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NARRAGANSETTE AVE APT B
OCEAN GATE NJ
08740-1371
US

IV. Provider business mailing address

815 NARRAGANSETTE AVE APT B
OCEAN GATE NJ
08740-1371
US

V. Phone/Fax

Practice location:
  • Phone: 732-267-4974
  • Fax:
Mailing address:
  • Phone: 732-267-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15184500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: