Provider Demographics
NPI:1679937296
Name:MCNABB, AMY (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCNABB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:COBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11333 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9311
Mailing Address - Country:US
Mailing Address - Phone:209-268-0560
Mailing Address - Fax:
Practice Address - Street 1:11333 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9311
Practice Address - Country:US
Practice Address - Phone:209-268-0560
Practice Address - Fax:209-214-6946
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily