Healthcare Provider Details

I. General information

NPI: 1063834653
Provider Name (Legal Business Name): TYSON HUTCHISON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 CR 830
FELDA FL
33930
US

IV. Provider business mailing address

3941 TAMIAMI TRL STE 3157 #2026
PUNTA GORDA FL
33950-7925
US

V. Phone/Fax

Practice location:
  • Phone: 239-744-6640
  • Fax: 877-673-2995
Mailing address:
  • Phone: 239-744-6640
  • Fax: 877-673-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9278598
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9278598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: