Provider Demographics
NPI:1073894374
Name:MICELI, AMY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:MICELI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4510 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1586
Mailing Address - Country:US
Mailing Address - Phone:602-618-1177
Mailing Address - Fax:623-869-9090
Practice Address - Street 1:2030 W WHISPERING WIND DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2853
Practice Address - Country:US
Practice Address - Phone:623-869-9080
Practice Address - Fax:623-869-9090
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2014-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4964363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical