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General NPI Number Information
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NPI Number | 1467177618
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Entity Type | Individual
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Provider Name | TREVOR AGOSTINO TOLMAN NNP
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Gender | Male
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1968 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1281
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Country | US
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Telephone | 208-539-5584
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Fax |
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Provider Business Mailing Address
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Address Line | 651 S 2400 W UNIT 1102
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City | REXBURG
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State | ID
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Zip | 83440-5167
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Country | US
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Telephone | 208-539-5584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 313157
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | GAA-NP00157
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License Number State | GA
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