Healthcare Provider Details

I. General information

NPI: 1386914810
Provider Name (Legal Business Name): MICHAEL THOMAS SVOBODA CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0165
  • Fax: 512-324-0786
Mailing address:
  • Phone: 512-324-0165
  • Fax: 512-324-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number748064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: