MEDICARE: MR. AUSTIN HUNTINGTON SIDES FNP

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	AP129073	TX

General Provider Information

NPI Number	:	1255702692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUSTIN HUNTINGTON SIDES FNP

Provider Business Mailing Address
First Line	:	1900 HOSPITAL BLVD
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2002
Country	:	US
Telephone Number	:	940-367-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N GRAND AVE
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-3573
Country	:	US
Telephone Number	:	940-367-5669
Fax Number	:

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

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/14/2015

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