Provider Demographics
NPI:1245299288
Name:NUGENT, AMY E (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:NUGENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7900 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-969-7266
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71001373A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00783823OtherRAILROAD MEDICARE
IN000000289907OtherANTHEM
IN200391110Medicaid
OH2463874Medicaid
IN260690SMedicare PIN
IN000000289907OtherANTHEM
IN200391110Medicaid