Provider Demographics
NPI:1710517941
Name:GAMINO, AMY (AGNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GAMINO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 WEST MEMORIAL DRIVE
Mailing Address - Street 2:SUIT 101
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132
Mailing Address - Country:US
Mailing Address - Phone:943-202-7870
Mailing Address - Fax:470-986-7205
Practice Address - Street 1:602 WEST MEMORIAL DRIVE
Practice Address - Street 2:SUIT 101
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132
Practice Address - Country:US
Practice Address - Phone:943-202-7870
Practice Address - Fax:470-986-7205
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256719163W00000X, 363LA2200X, 163WX0200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology