Healthcare Provider Details

I. General information

NPI: 1568967230
Provider Name (Legal Business Name): TYLER PAUL THORNE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE STE 107
TAMPA FL
33614-7143
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0030
  • Fax:
Mailing address:
  • Phone: 480-480-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS19573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: