Provider Demographics
NPI:1568793602
Name:JARVIS, AMANDA D (MSN, APRN, FNP, CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:JARVIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-5547
Mailing Address - Country:US
Mailing Address - Phone:740-891-9000
Mailing Address - Fax:
Practice Address - Street 1:915 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-5547
Practice Address - Country:US
Practice Address - Phone:740-891-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner