MEDICARE: TIFFANY TYLER APRN-CNP

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	363LP2300X	Primary Care Nurse Practitioner	99349	OK

General Provider Information

NPI Number	:	1609316264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY TYLER APRN-CNP

Provider Business Mailing Address
First Line	:	5050 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6711
Country	:	US
Telephone Number	:	918-355-9492
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6711
Country	:	US
Telephone Number	:	918-335-9492
Fax Number	:

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	01/12/2018

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