Healthcare Provider Details

I. General information

NPI: 1134644487
Provider Name (Legal Business Name): TYLER BROOKS WINDSOR CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

IV. Provider business mailing address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-0329
  • Fax: 844-212-7396
Mailing address:
  • Phone: 850-769-0329
  • Fax: 844-212-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-140375
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-140375
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9486854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: