Provider Demographics
NPI:1871661223
Name:ROBBINS, AMY BETH (CFNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:454 ST MICHAELS DRIVE
Practice Address - Street 2:PMG ST MICHAELS
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-473-0390
Practice Address - Fax:505-473-0375
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704185046363L00000X
NMCNP-02499363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-0-87-7365OtherBCBS INDIVIDUAL
MI50-0-601381OtherBCBS GROUP
MI1871661223Medicaid
MI50-0-601381OtherBCBS GROUP