Healthcare Provider Details

I. General information

NPI: 1093203721
Provider Name (Legal Business Name): TYRZA HOINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 12TH AVE S
FARGO ND
58103-8753
US

IV. Provider business mailing address

PO BOX 9859
FARGO ND
58106-9859
US

V. Phone/Fax

Practice location:
  • Phone: 701-451-4900
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1217-7-15-22A
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: