Provider Demographics
NPI:1144000944
Name:ELFEZZAZI, AMANDA A (APRN-CNP, AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:A
Last Name:ELFEZZAZI
Suffix:
Gender:F
Credentials:APRN-CNP, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1931
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-1931
Mailing Address - Country:US
Mailing Address - Phone:918-774-5883
Mailing Address - Fax:
Practice Address - Street 1:416420 ENSIGN LN
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2287
Practice Address - Country:US
Practice Address - Phone:918-774-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty