Provider Demographics
NPI:1760148092
Name:TOLAR, DUSTIN RYAN (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:RYAN
Last Name:TOLAR
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1902 WINDSOR PL STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1866
Mailing Address - Country:US
Mailing Address - Phone:682-207-1700
Mailing Address - Fax:682-250-5246
Practice Address - Street 1:1902 WINDSOR PL STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1866
Practice Address - Country:US
Practice Address - Phone:682-207-1700
Practice Address - Fax:682-250-5246
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1058628363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner