Healthcare Provider Details

I. General information

NPI: 1093459976
Provider Name (Legal Business Name): TYLER RUPPEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 6008
MIAMI FL
33133-4221
US

IV. Provider business mailing address

500 N ANDREWS AVE APT 401
FORT LAUDERDALE FL
33301-4146
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-6555
  • Fax: 305-856-6556
Mailing address:
  • Phone: 813-841-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS24023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: