=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730226671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS FLOYD COYE R.N.P.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3230 PEACEKEEPER WAY
-----------------------------------------------------
City | MCCLELLAN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95652-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-830-1515
-----------------------------------------------------
Fax | 916-929-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25191 TASMAN RD
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-510-4751
-----------------------------------------------------
Fax | 916-929-1861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 361549
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------