Provider Demographics
NPI:1710627534
Name:STUBBLEFIELD, AMANDA RENEER (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEER
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:RENEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:8535 BLANCO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3040
Practice Address - Country:US
Practice Address - Phone:210-880-0006
Practice Address - Fax:210-579-1852
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily