Provider Demographics
NPI:1386933216
Name:AMAZAN-RODNEY, GERLY (FNP)
Entity type:Individual
Prefix:
First Name:GERLY
Middle Name:
Last Name:AMAZAN-RODNEY
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 1:400 CAPITAL BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3576
Mailing Address - Country:US
Mailing Address - Phone:860-335-6628
Mailing Address - Fax:855-576-1242
Practice Address - Street 1:400 CAPITAL BLVD FL 3
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3576
Practice Address - Country:US
Practice Address - Phone:860-335-6628
Practice Address - Fax:855-576-1242
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004127363LF0000X
NY335388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily