MEDICARE: MR. ANTHONY THOMAS NYE APRN AG/ACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	95004017	CA

General Provider Information

NPI Number	:	1962864850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY THOMAS NYE APRN AG/ACNP-BC

Provider Business Mailing Address
First Line	:	505 PARNASSUS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2204
Country	:	US
Telephone Number	:	918-978-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 N MCKINLEY AVE
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7813
Country	:	US
Telephone Number	:	918-978-9978
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	11/20/2020

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