MEDICARE: TAB WAYNE HOYT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN057335	AZ

General Provider Information

NPI Number	:	1174666564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAB WAYNE HOYT FNP

Provider Business Mailing Address
First Line	:	5850 N MOUNTAIN LION LN
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-8221
Country	:	US
Telephone Number	:	520-682-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 W SWEETWATER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9348
Country	:	US
Telephone Number	:	520-743-2150
Fax Number	:	520-743-2186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	06/01/2010

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