Healthcare Provider Details

I. General information

NPI: 1427640770
Provider Name (Legal Business Name): TYLA DANIELLE HORNBUCKLE MSN, RNFA, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MIDFIELD DR
MONTGOMERY AL
36111-1529
US

IV. Provider business mailing address

800 VALLEY CIR
LEEDS AL
35094-2408
US

V. Phone/Fax

Practice location:
  • Phone: 786-346-8646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1168693
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: