Provider Demographics
NPI:1508695768
Name:MAZZA, AMY (RN/BSN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MAZZA
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 FERRARI DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6304
Mailing Address - Country:US
Mailing Address - Phone:862-266-6326
Mailing Address - Fax:
Practice Address - Street 1:1836 FERRARI DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6304
Practice Address - Country:US
Practice Address - Phone:862-266-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12187700163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty