Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Amy Michelle Provenzano, CPNP-PC

Individual provider Pediatric Nurse Practitioner · NPI 1487178687

Amy Michelle Provenzano, CPNP-PC is a Pediatric Nurse Practitioner in Warren, New Jersey. Licensed in California, New Jersey and Ohio. Registered with an NPI since 2017.

Licensed in
CA, NJ, OH
In the registry since
2017
Specialties on file
3

Practice location Address checks out

67A Mountain Boulevard Ext 1st Fl Unit B
Warren, NJ 07059
Phone: (858) 216-8837
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence NUR-2023-000730 (NJ)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence APRN.CNP.021402 (OH)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 95022954 (CA)

Record details

NPI number1487178687
Entity typeIndividual (Type 1)
GenderFemale
Credentials CPNP-PC
Sole proprietorNo
NPI enumeratedJuly 28, 2017
Last updated in NPPESFebruary 2, 2023
Certification dateFebruary 1, 2023

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