MEDICARE: AUSTIN FANN FNP-C

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	5019605	NC

General Provider Information

NPI Number	:	1730943663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN FANN FNP-C

Provider Business Mailing Address
First Line	:	1145 MCPHAIL RD
Second Line	:
City	:	ROSEBORO
State	:	NC
Zip	:	28382-7066
Country	:	US
Telephone Number	:	910-214-6792
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 OLD ROBERTS RD # 102
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8047
Country	:	US
Telephone Number	:	919-934-2600
Fax Number	:

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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