MEDICARE: HANNA LEIGH COYLE 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	718545	TX

General Provider Information

NPI Number	:	1770952178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA LEIGH COYLE FNP

Provider Business Mailing Address
First Line	:	3515 RICHMOND RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0711
Country	:	US
Telephone Number	:	903-791-9355
Fax Number	:	903-831-7258

Provider Business Practice Location Address
First Line	:	711 E END BLVD S
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75670-5615
Country	:	US
Telephone Number	:	903-938-4363
Fax Number	:	903-935-7394

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

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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