Provider Demographics
NPI:1275614786
Name:VINIK, AMY (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VINIK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1843
Mailing Address - Country:US
Mailing Address - Phone:520-647-8854
Mailing Address - Fax:520-647-8851
Practice Address - Street 1:1601 W ST. MARY'S ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-647-8854
Practice Address - Fax:520-647-8851
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3480363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112798Medicare PIN