Provider Demographics
NPI:1962564542
Name:ZMYSLINSKI, AMY (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ZMYSLINSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:NEDRESKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-4144
Mailing Address - Fax:
Practice Address - Street 1:1745 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3924
Practice Address - Country:US
Practice Address - Phone:916-983-2302
Practice Address - Fax:916-983-2382
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant