Healthcare Provider Details

I. General information

NPI: 1548327083
Provider Name (Legal Business Name): RENAY TYLER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

1120 RYEGATE RD
TOWSON MD
21286-1745
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2590
  • Fax: 410-955-4870
Mailing address:
  • Phone: 410-583-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberR072779
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR072779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: