Provider Demographics
NPI:1689329930
Name:AMAZING GRACE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:AMAZING GRACE HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINTHIA
Authorized Official - Middle Name:DAYANARA
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:252-864-1431
Mailing Address - Street 1:845 JOHNS HOPKINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7200
Mailing Address - Country:US
Mailing Address - Phone:252-864-1431
Mailing Address - Fax:
Practice Address - Street 1:845 JOHNS HOPKINS DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7200
Practice Address - Country:US
Practice Address - Phone:252-864-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty