Healthcare Provider Details

I. General information

NPI: 1801219233
Provider Name (Legal Business Name): THOMAS JUSTIN HUFFER MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NORTHRIDGE RD.
CIRCLEVILLE OH
43113-0578
US

IV. Provider business mailing address

PO BOX 578
CIRCLEVILLE OH
43113-0578
US

V. Phone/Fax

Practice location:
  • Phone: 740-474-3159
  • Fax: 740-474-2110
Mailing address:
  • Phone: 740-474-3159
  • Fax: 740-474-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCOA15441-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: