Provider Demographics
NPI:1356473565
Name:MAZE, AMBRE E (MS, PAC)
Entity Type:Individual
Prefix:MRS
First Name:AMBRE
Middle Name:E
Last Name:MAZE
Suffix:
Gender:F
Credentials:MS, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2922
Mailing Address - Country:US
Mailing Address - Phone:844-505-4799
Mailing Address - Fax:615-907-5885
Practice Address - Street 1:5080 FLORENCE RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2922
Practice Address - Country:US
Practice Address - Phone:844-505-4799
Practice Address - Fax:615-907-5885
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN856363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN856OtherSTATE LICENSE
TN856OtherSTATE LICENSE