Provider Demographics
NPI:1790251015
Name:PONZIO, AMY KRISTINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KRISTINE
Last Name:PONZIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 FRANCISCAN DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2544
Mailing Address - Country:US
Mailing Address - Phone:979-731-6000
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST STE 305
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2587
Practice Address - Country:US
Practice Address - Phone:979-690-4825
Practice Address - Fax:979-690-4826
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP139086363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care