MEDICARE: DIANNE A TOBIN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AZ334	AZ

General Provider Information

NPI Number	:	1083614168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE A TOBIN FNP-C

Provider Business Mailing Address
First Line	:	4450 W MARLOW RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-5515
Country	:	US
Telephone Number	:	928-445-8587
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 N HIGHWAY 89
Second Line	:
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-5993
Country	:	US
Telephone Number	:	928-636-4355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/15/2014

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