Healthcare Provider Details

I. General information

NPI: 1013980432
Provider Name (Legal Business Name): KIMBERLY LYNN TYLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY STE 218
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

2415 UNIVERSITY PKWY STE 218
SARASOTA FL
34243-2809
US

V. Phone/Fax

Practice location:
  • Phone: 941-955-6220
  • Fax:
Mailing address:
  • Phone: 941-955-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000595
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF331853
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1100595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: