Amy Michelle Provenzano, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

NUR-2023-000730 Issued in NJ

Practice address

67A Mountain Boulevard Ext
1St Floor, Unit B
Warren, NJ 07059

Phone

(858) 216-8837

NPI assigned

Jul 28, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23216/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/14973/brand/8/csg/1/fhir/r4
• Direct secure messaging: amy.provenzano.1@14973.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sozo Pediatrics

  • Primary Care Clinic/Center
  • Lancaster, OH
  • NPI 1831757822
  NPD Authorized official
• Cortica New Jersey Developmental Therapies, PC

  • Developmental Disabilities Clinic/Center
  • Warren, NJ
  • NPI 1104589365
  NPD (past)
• Cortica Healthcare Inc

  dba Pediatric Neurology Therapeutics PC

  • Health Service Clinic/Center
  • San Diego, CA
  • NPI 1801288535
  NPD (past)

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1487178687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 ORWELL ST",
            "city": "LITHOPOLIS",
            "state": "OH",
            "postal_code": "431369723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67A MOUNTAIN BOULEVARD EXT",
            "address_2": "1ST FLOOR, UNIT B",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "07059",
            "telephone_number": "858-216-8837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "AMY",
        "middle_name": "MICHELLE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-28",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.021402",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "NUR-2023-000730",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95022954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Harmony Place LLC (Positive Reset Services)
• Gabriel Cheng-Kwei Price, RN
• Primehealth Preferred LLC
• Caroline Prins, MD
• Professional Anesthesia Physicians
• Kai Pun, P.T.
• Melissa Quiros Castaneda, BCBA
• Vidya Juluru Rao, MD
• Rebecca Lu MD (Elite SkinMD)
• Chrystal Reddersen-Picaro

• Pediatric Nurse Practitioner in Warren, NJ
• Providers in Warren, NJ by specialty
• Pediatric Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; 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.