Healthcare Provider Details

I. General information

NPI: 1790381820
Provider Name (Legal Business Name): BRENDA TYLOR AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 E BAYWOOD AVE STE 507
MESA AZ
85206-1749
US

IV. Provider business mailing address

1220 E BAYLOR CT
GILBERT AZ
85296-4365
US

V. Phone/Fax

Practice location:
  • Phone: 480-684-6487
  • Fax:
Mailing address:
  • Phone: 480-296-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number250556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: