Provider Demographics
NPI:1437614518
Name:SPOSATO, AMANDA RAE (MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RAE
Last Name:SPOSATO
Suffix:
Gender:F
Credentials:MSN, RN
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Mailing Address - Street 1:5839 LOS CERRITOS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2048
Mailing Address - Country:US
Mailing Address - Phone:915-422-2511
Mailing Address - Fax:
Practice Address - Street 1:311 CAMDEN ST STE 510
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2015
Practice Address - Country:US
Practice Address - Phone:210-591-1615
Practice Address - Fax:210-591-1635
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2020-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX770968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403725101Medicaid