Provider Demographics
NPI:1508687559
Name:PETERS, AMY (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PETERS
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 1:815 NARRAGANSETTE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-1371
Mailing Address - Country:US
Mailing Address - Phone:732-267-4974
Mailing Address - Fax:
Practice Address - Street 1:815 NARRAGANSETTE AVE APT B
Practice Address - Street 2:
Practice Address - City:OCEAN GATE
Practice Address - State:NJ
Practice Address - Zip Code:08740-1371
Practice Address - Country:US
Practice Address - Phone:732-267-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15184500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily