Provider Demographics
NPI:1710517941
Name:GAMINO, AMY (AGNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GAMINO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 NEWNAN ESTATES DR APT 43
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1152
Mailing Address - Country:US
Mailing Address - Phone:678-340-2150
Mailing Address - Fax:
Practice Address - Street 1:53 NEWNAN ESTATES DR APT 43
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1152
Practice Address - Country:US
Practice Address - Phone:678-340-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256719163W00000X, 163WM0705X, 163WX0200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WX0200XNursing Service ProvidersRegistered NurseOncology