Provider Demographics
NPI:1932842028
Name:ROLSTON, AMY LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:ROLSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1725
Mailing Address - Country:US
Mailing Address - Phone:440-830-9247
Mailing Address - Fax:
Practice Address - Street 1:107 VINEYARD RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1725
Practice Address - Country:US
Practice Address - Phone:440-830-9247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4018792363LF0000X
OHAPRN.CNP.0027465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily