Provider Demographics
NPI:1841518487
Name:DIZZINE, AMANDA JEAN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:DIZZINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 N SAN SABA
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3154
Mailing Address - Country:US
Mailing Address - Phone:210-704-4275
Mailing Address - Fax:210-704-4527
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4275
Practice Address - Fax:210-704-4527
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122908363L00000X, 363LP0200X
FLARNP9254008363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner