Healthcare Provider Details

I. General information

NPI: 1528608577
Provider Name (Legal Business Name): NICOLE ANN TYMANN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPRINGFIELD DR STE 100
BLOOMINGDALE IL
60108-2215
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 888-693-6437
  • Fax: 630-946-2363
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209020840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: