Healthcare Provider Details

I. General information

NPI: 1013862036
Provider Name (Legal Business Name): SYDNEY TYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 COUNTY ROAD 220
MIDDLEBURG FL
32068-4359
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 904-291-2221
  • Fax: 904-291-9192
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: