Healthcare Provider Details

I. General information

NPI: 1235057266
Provider Name (Legal Business Name): ANDREW DOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10482 W CARLTON BAY DR
GARDEN CITY ID
83714-5143
US

IV. Provider business mailing address

13896 W DAIMLER CT
BOISE ID
83713-1274
US

V. Phone/Fax

Practice location:
  • Phone: 208-955-6500
  • Fax:
Mailing address:
  • Phone: 208-971-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number49774
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: