1386893154 NPI number — MR. TIMOTHY MICHAEL PATRICK FLYNN FNP

Table of content: MR. TIMOTHY MICHAEL PATRICK FLYNN FNP (NPI 1386893154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386893154 NPI number — MR. TIMOTHY MICHAEL PATRICK FLYNN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
TIMOTHY
Provider Middle Name:
MICHAEL PATRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386893154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 CONGRESS AVE
Provider Second Line Business Mailing Address:
SUITE E1.214
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-463-0313
Provider Business Mailing Address Fax Number:
512-463-6237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 CONGRESS AVE
Provider Second Line Business Practice Location Address:
SUITE E1.214
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-463-0313
Provider Business Practice Location Address Fax Number:
512-463-6237
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  521808 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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