Individual provider Active NPI

Amanda Maureen Palazzolo, DNP, FNP-C

  • Family Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1689342461
Registry record updated Nov 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
258833 Issued in AZ
Practice address
1300 S Country Club Dr Ste 3
Mesa, AZ 85210-5162
Phone
(480) 827-5500
NPI assigned
Sep 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 258833 AZ Primary

Addresses

Primary practice location

1300 S Country Club Dr Ste 3
Mesa, AZ 85210-5162

Mailing address

1300 S Country Club Dr Ste 3
Mesa, AZ 85210-5162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211109002791 AZ Practitioner - Nurse Practitioner 0749679959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1435 S Alma School Rd
Chandler, AZ 85286-7144
Phone (480) 668-1600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Primary Care Physicians Arizona LLC CurrentSince Oct 20, 2021 Accepting new patients
Banner Primary Care Physicians Arizona LLC Current Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Oct 20, 2021 Accepting new patients

Locations

1435 S Alma School Rd
Chandler, AZ 85286
Phone (480) 668-1600

1300 S Country Club Dr
Ste 3
Mesa, AZ 85210
Phone (480) 827-5500

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1630800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637452800000",
    "number": "1689342461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S COUNTRY CLUB DR STE 3",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S COUNTRY CLUB DR STE 3",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105162",
            "telephone_number": "480-827-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALAZZOLO",
        "first_name": "AMANDA",
        "middle_name": "MAUREEN",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-05",
        "last_updated": "2021-11-21",
        "certification_date": "2021-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "258833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.