Healthcare Provider Details

I. General information

NPI: 1245183011
Provider Name (Legal Business Name): TYRA A GOOGE CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TYRA DUKES

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE. YACC 4
BOSTON MA
02118
US

IV. Provider business mailing address

70 SHEAFE ST
MALDEN MA
02148-6029
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2333352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: