Healthcare Provider Details

I. General information

NPI: 1386893154
Provider Name (Legal Business Name): TIMOTHY MICHAEL PATRICK FLYNN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CONGRESS AVE SUITE E1.214
AUSTIN TX
78701-1932
US

IV. Provider business mailing address

1400 CONGRESS AVE SUITE E1.214
AUSTIN TX
78701-1932
US

V. Phone/Fax

Practice location:
  • Phone: 512-463-0313
  • Fax: 512-463-6237
Mailing address:
  • Phone: 512-463-0313
  • Fax: 512-463-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number521808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: