Provider Demographics
NPI:1790857290
Name:AGUIAR, AMELIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:AGUIAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1721
Mailing Address - Country:US
Mailing Address - Phone:931-219-2091
Mailing Address - Fax:931-219-2182
Practice Address - Street 1:817 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1721
Practice Address - Country:US
Practice Address - Phone:931-219-2091
Practice Address - Fax:931-219-2182
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09052-NP363L00000X
TN33453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2737720Medicaid
OHQ73501Medicare UPIN
OHNP22281Medicare PIN
OHNP22283Medicare PIN