Provider Demographics
NPI:1144928631
Name:AMIKAL HEALTHCARE LLC
Entity type:Organization
Organization Name:AMIKAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIEN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:305-522-8939
Mailing Address - Street 1:1689 S. PARKCREST STREET
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0615
Mailing Address - Country:US
Mailing Address - Phone:305-522-8939
Mailing Address - Fax:
Practice Address - Street 1:3101 N CENTRAL AVENUE
Practice Address - Street 2:SUITE 183
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2587
Practice Address - Country:US
Practice Address - Phone:305-522-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty