Provider Demographics
NPI:1073361416
Name:VENTURA, GERRY AMLOG (FNP-C)
Entity type:Individual
Prefix:
First Name:GERRY
Middle Name:AMLOG
Last Name:VENTURA
Suffix:
Gender:M
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 1:9750 N 96TH ST APT 271
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5298
Mailing Address - Country:US
Mailing Address - Phone:480-323-0086
Mailing Address - Fax:
Practice Address - Street 1:9750 N 96TH ST APT 271
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5298
Practice Address - Country:US
Practice Address - Phone:480-323-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily