Provider Demographics
NPI:1376918383
Name:FAST, ERIC (FNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:FAST
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 1:191 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5177
Mailing Address - Country:US
Mailing Address - Phone:208-944-0369
Mailing Address - Fax:
Practice Address - Street 1:191 ADDISON AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5177
Practice Address - Country:US
Practice Address - Phone:208-944-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60627369363L00000X
IDNP-1692A363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1376918383OtherIPN-IDAHO PHYSICIANS NETWORK
ID1376918383OtherIPN-IDAHO PHYSICIANS NETWORK
WAG8949998Medicare PIN