Provider Demographics
NPI:1952321440
Name:GEORGE, AMY CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:TANGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4532 E PEAK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6292
Mailing Address - Country:US
Mailing Address - Phone:480-282-3676
Mailing Address - Fax:
Practice Address - Street 1:5757 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5000
Practice Address - Country:US
Practice Address - Phone:480-282-3676
Practice Address - Fax:855-289-6637
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ143275Medicaid
AZP00625194OtherRAILROAD MEDICARE
Q72341Medicare UPIN
AZZ142796Medicare PIN