MEDICARE: AMANDA CORMICAN APRN, CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APRN001655	NV

General Provider Information

NPI Number	:	1598187643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CORMICAN APRN, CPNP-PC

Provider Business Mailing Address
First Line	:	3601 LAS VEGAS BLVD N STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7507
Country	:	US
Telephone Number	:	702-200-2790
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 LAS VEGAS BLVD N STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7507
Country	:	US
Telephone Number	:	702-200-2790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	09/11/2025

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