Provider Demographics
NPI:1013405133
Name:CORDERO, AMANDA JO (CRNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:CORDERO
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 BALMORAL DR SW STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6456
Mailing Address - Country:US
Mailing Address - Phone:256-882-6555
Mailing Address - Fax:
Practice Address - Street 1:4245 BALMORAL DR SW STE 102
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6456
Practice Address - Country:US
Practice Address - Phone:256-882-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24205363LF0000X
AL1-147493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-147493OtherDIRECT PRIMARY CARE CLINIC