Provider Demographics
NPI:1154467579
Name:ERNST-AMADOR, ALYCIA SUSAN (FNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:ALYCIA
Middle Name:SUSAN
Last Name:ERNST-AMADOR
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:MS
Other - First Name:ALYCIA
Other - Middle Name:SUSAN
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5528 E HILLERY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2375
Mailing Address - Country:US
Mailing Address - Phone:480-399-2497
Mailing Address - Fax:480-946-2559
Practice Address - Street 1:8417 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3917
Practice Address - Country:US
Practice Address - Phone:480-946-3399
Practice Address - Fax:480-946-2559
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5137363LF0000X
AZRN101841163W00000X
AZB101841163WS0200X
AZ2009005747364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ891748OtherAHCCCS