Healthcare Provider Details

I. General information

NPI: 1669642237
Provider Name (Legal Business Name): TAHIRAH A TYRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAHIRAH A TYRELL MD

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-5365
  • Fax: 561-955-3577
Mailing address:
  • Phone: 561-955-5365
  • Fax: 816-617-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberME115083
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME115083
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number269460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: