Healthcare Provider Details

I. General information

NPI: 1548733587
Provider Name (Legal Business Name): TYLER D MCCARTHY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST E
BRADENTON FL
34208-1042
US

IV. Provider business mailing address

6304 13TH AVE E
BRADENTON FL
34208-6322
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-5111
  • Fax:
Mailing address:
  • Phone: 941-524-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: