Healthcare Provider Details

I. General information

NPI: 1679824304
Provider Name (Legal Business Name): TYLER J LOXLEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

IV. Provider business mailing address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2003
  • Fax: 239-337-1483
Mailing address:
  • Phone: 239-337-2003
  • Fax: 239-337-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: