Provider Demographics
NPI:1649718602
Name:CERNOSEK, AMANDA G I (CFNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:CERNOSEK
Suffix:I
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 N VON MINDEN ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1262
Mailing Address - Country:US
Mailing Address - Phone:979-968-8493
Mailing Address - Fax:979-968-6388
Practice Address - Street 1:1253 N VON MINDEN ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1262
Practice Address - Country:US
Practice Address - Phone:979-968-8493
Practice Address - Fax:979-968-6388
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily