=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629844618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY PRIMORAC FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2023
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 FREEDOM PKWY STE C
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312-4939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-545-0911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 AURORA RD
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27278-8119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-667-8530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5019206
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------