Provider Demographics
NPI:1275160293
Name:ARNOLD, TODD MICHAEL (FNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6237
Mailing Address - Country:US
Mailing Address - Phone:573-228-1966
Mailing Address - Fax:
Practice Address - Street 1:131 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6237
Practice Address - Country:US
Practice Address - Phone:573-228-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA158225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty