Healthcare Provider Details

I. General information

NPI: 1902532666
Provider Name (Legal Business Name): TYLER JAMES LAMONICA MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HULL RD
GAINESVILLE FL
32611-1098
US

IV. Provider business mailing address

506 SE SANCHEZ AVE
OCALA FL
34471-3827
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9823
  • Fax: 352-273-7395
Mailing address:
  • Phone: 716-708-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003542-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: