Provider Demographics
NPI:1346021672
Name:MASTRONARDI, AMBER ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:MASTRONARDI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ROSE
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:PORT CLYDE
Mailing Address - State:ME
Mailing Address - Zip Code:04855-0296
Mailing Address - Country:US
Mailing Address - Phone:207-542-9530
Mailing Address - Fax:
Practice Address - Street 1:4 GLEN COVE DR STE 103
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4236
Practice Address - Country:US
Practice Address - Phone:207-301-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily