Provider Demographics
NPI:1356805220
Name:AZEVEDO, AMANDA CHRISTINE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 7TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3218
Mailing Address - Country:US
Mailing Address - Phone:888-478-8432
Mailing Address - Fax:
Practice Address - Street 1:322 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5617
Practice Address - Country:US
Practice Address - Phone:888-478-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily