Provider Demographics
NPI:1588340657
Name:CENICEROS, AMANDA FORD (FNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FORD
Last Name:CENICEROS
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-795-4783
Mailing Address - Fax:520-547-5797
Practice Address - Street 1:6236 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3154
Practice Address - Country:US
Practice Address - Phone:520-327-6874
Practice Address - Fax:520-327-0028
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ293846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine