Healthcare Provider Details

I. General information

NPI: 1619090958
Provider Name (Legal Business Name): ALISA D TYLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SW 13TH ST ATTN BILLING & COLLECTIONS
GAINESVILLE FL
32608-4006
US

IV. Provider business mailing address

4300 SW 13TH ST ATTN BILLING & COLLECTIONS
GAINESVILLE FL
32608-4006
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax: 352-375-0298
Mailing address:
  • Phone: 352-374-5600
  • Fax: 352-375-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6913
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9167805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: