Provider Demographics
NPI:1821014531
Name:HUFFORD, AMANDA SEALS (NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SEALS
Last Name:HUFFORD
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:SEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-277-4161
Mailing Address - Fax:602-274-3394
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:375
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:602-274-3394
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ97341363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969404Medicaid