Healthcare Provider Details

I. General information

NPI: 1174851745
Provider Name (Legal Business Name): ANGELA FRANCES TYUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 E SHOTWELL ST
BAINBRIDGE GA
39819-4146
US

IV. Provider business mailing address

832 E SHOTWELL ST
BAINBRIDGE GA
39819-4146
US

V. Phone/Fax

Practice location:
  • Phone: 229-231-6146
  • Fax: 229-207-4127
Mailing address:
  • Phone: 229-231-6146
  • Fax: 229-207-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN143534
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: