Amanda Gordon Cancilla, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

005001127 Issued in NC

Practice address

225 Baldwin Ave
Charlotte, NC 28204-3109

Phone

(704) 376-1605

NPI assigned

Mar 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1144289000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANCILLA",
        "first_name": "AMANDA",
        "middle_name": "GORDON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "005001127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Campus Medical LLC
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• Lyssa Canales
• Cody Alexander Canavan, MD
• Victor Ignacio Candelario, APRN
• Lisa Atlas Candon, DDS
• Cathy Canepa, M.D.
• Meghan Elizabeth Canfield, OTR/L
• Whitney Jo Canfield, RD

• Acute Care Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Acute Care Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.