Provider Demographics
NPI:1215181631
Name:PADILLA, AMY (NP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 30TH AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8419
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:866-397-7399
Practice Address - Street 1:1509 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5027
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:866-397-7399
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNANP0000007891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily