Healthcare Provider Details

I. General information

NPI: 1164980017
Provider Name (Legal Business Name): DEBORAH ANN TYSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 MALL RD
FLORENCE AL
35630-1641
US

IV. Provider business mailing address

2904 MALL RD
FLORENCE AL
35630-1641
US

V. Phone/Fax

Practice location:
  • Phone: 256-767-3330
  • Fax:
Mailing address:
  • Phone: 256-767-3330
  • Fax: 949-695-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-118983
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-118983
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: