Healthcare Provider Details

I. General information

NPI: 1912712928
Provider Name (Legal Business Name): CLINTON TYLER HOBBS AGPCNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 OLDE WATERFORD WAY STE 1C
LELAND NC
28451-4168
US

IV. Provider business mailing address

1108 MERRION AVE APT 308
DURHAM NC
27703-0538
US

V. Phone/Fax

Practice location:
  • Phone: 910-834-2240
  • Fax: 919-661-1697
Mailing address:
  • Phone: 910-620-9576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5022211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: