Healthcare Provider Details

I. General information

NPI: 1467374009
Provider Name (Legal Business Name): TRAVIS EDWARD DYER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 49TH ST N UNIT 307
PINELLAS PARK FL
33781-3440
US

IV. Provider business mailing address

7780 49TH ST N UNIT 307
PINELLAS PARK FL
33781-3440
US

V. Phone/Fax

Practice location:
  • Phone: 630-885-6994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11049555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: