Provider Demographics
NPI:1700227030
Name:TYMN, AMANDA A (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:TYMN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3235
Mailing Address - Country:US
Mailing Address - Phone:559-432-4303
Mailing Address - Fax:559-432-4574
Practice Address - Street 1:1207 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3235
Practice Address - Country:US
Practice Address - Phone:559-432-4303
Practice Address - Fax:559-432-4574
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner