MEDICARE: TUESDAY M KAYONGO APRN-CNP

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	163WC0200X	Critical Care Medicine Registered Nurse	707348	TX
2	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	AP133041	TX
3	363LA2100X	Acute Care Nurse Practitioner	AP133041	TX

General Provider Information

NPI Number	:	1871449744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUESDAY M KAYONGO APRN-CNP

Provider Business Mailing Address
First Line	:	1696 ROSEVILLE ST
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-5559
Country	:	US
Telephone Number	:	469-536-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 GIVERNY CT
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-3650
Country	:	US
Telephone Number	:	469-536-9006
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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