Basic Information
| Provider Information | |||||||||
| NPI: | 1881634897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | APN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 WALLER ST | ||||||||
| Address2: | ATTN: FINANCE, 5TH FLOOR | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787025240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789000 | ||||||||
| FaxNumber: | 5129789001 | ||||||||
| Practice Location | |||||||||
| Address1: | 4614 N IH 35 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787513401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789100 | ||||||||
| FaxNumber: | 5124488264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 650479 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 650479 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 124805607 | 05 | TX | MEDICAID |