Healthcare Provider Details

I. General information

NPI: 1346782398
Provider Name (Legal Business Name): TYSON H KUCH R.N., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 W KENNEDY BLVD
ORLANDO FL
32810-6237
US

IV. Provider business mailing address

1515 ADANSON STREET C/O HUMAN RESOURCES
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-3700
  • Fax:
Mailing address:
  • Phone: 407-875-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9314850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: