Provider Demographics
NPI:1962218917
Name:BRECKENRIDGE, AMICUA (FNP-C)
Entity type:Individual
Prefix:
First Name:AMICUA
Middle Name:
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMICUA
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6104 S 1ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4052
Mailing Address - Country:US
Mailing Address - Phone:512-856-9596
Mailing Address - Fax:
Practice Address - Street 1:6104 S 1ST ST STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4052
Practice Address - Country:US
Practice Address - Phone:512-856-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily