Provider Demographics
NPI:1790546596
Name:CARNEVALE, AMANDA ASHLEY
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ASHLEY
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10443 SKYE SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-1223
Mailing Address - Country:US
Mailing Address - Phone:352-270-1538
Mailing Address - Fax:
Practice Address - Street 1:10443 SKYE SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1223
Practice Address - Country:US
Practice Address - Phone:352-270-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9637962163W00000X
NV824146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse