Healthcare Provider Details

I. General information

NPI: 1750634648
Provider Name (Legal Business Name): TENISIA LASHAE TYRE ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WINGS WAY
LEHIGH ACRES FL
33936-3601
US

IV. Provider business mailing address

3207 BIRCHIN LN
FORT MYERS FL
33916-4579
US

V. Phone/Fax

Practice location:
  • Phone: 239-333-4250
  • Fax: 239-333-4251
Mailing address:
  • Phone: 239-246-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberAPRN3421362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 3421362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: