Provider Demographics
NPI:1033359252
Name:AMBERSLEY, SHIREEN A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHIREEN
Middle Name:A
Last Name:AMBERSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14300 STATLER BLVD APT 617
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2843
Mailing Address - Country:US
Mailing Address - Phone:845-430-5178
Mailing Address - Fax:817-545-7988
Practice Address - Street 1:007 CHOOSGAI DRIVE
Practice Address - Street 2:
Practice Address - City:TOHATCHI
Practice Address - State:NM
Practice Address - Zip Code:87325
Practice Address - Country:US
Practice Address - Phone:505-733-8400
Practice Address - Fax:817-545-7988
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TXAP134154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator