Provider Demographics
NPI:1598187643
Name:CORMICAN, AMANDA (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CORMICAN
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 LAS VEGAS BLVD N STE 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0587
Mailing Address - Country:US
Mailing Address - Phone:702-262-0037
Mailing Address - Fax:702-272-2421
Practice Address - Street 1:4375 LAS VEGAS BLVD N STE 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0587
Practice Address - Country:US
Practice Address - Phone:702-262-0037
Practice Address - Fax:702-272-2421
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics