Provider Demographics
NPI:1790229110
Name:FORD, AMY (MSN, WHNP-BC, CNM-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MSN, WHNP-BC, CNM-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VIA VERONA
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3746
Mailing Address - Country:US
Mailing Address - Phone:208-651-6311
Mailing Address - Fax:833-992-2457
Practice Address - Street 1:309 23RD ST STE 220
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1700
Practice Address - Country:US
Practice Address - Phone:917-426-2223
Practice Address - Fax:833-992-2457
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01295600363L00000X
GAGAA-NP000625363L00000X
IL025256363L00000X
CT10548363L00000X
FLAPRN11000981367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife