MEDICARE: RYAN ANDREW ZOELLER 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	163W00000X	Registered Nurse	041465817	IL
2	363L00000X	Nurse Practitioner	209026668	IL
3	363L00000X	Nurse Practitioner	1152911	TX

General Provider Information

NPI Number	:	1538872056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ANDREW ZOELLER FNP-C

Provider Business Mailing Address
First Line	:	101 W LOUIS HENNA BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 S MOPAC EXPY STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1113
Country	:	US
Telephone Number	:	512-244-4272
Fax Number	:	512-244-2895

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

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	08/09/2024

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