Provider Demographics
NPI:1295544179
Name:SANDOVAL, AMBER NICHOLE (NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 CHESTNUT ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4908
Mailing Address - Country:US
Mailing Address - Phone:720-412-6866
Mailing Address - Fax:
Practice Address - Street 1:3501 N 24TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6607
Practice Address - Country:US
Practice Address - Phone:602-698-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258444363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care