Healthcare Provider Details

I. General information

NPI: 1801268339
Provider Name (Legal Business Name): TAMARA TYLER X RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 E SHORE RD
WESTPORT IS ME
04578-3520
US

IV. Provider business mailing address

286 E SHORE RD
WESTPORT IS ME
04578-3520
US

V. Phone/Fax

Practice location:
  • Phone: 207-610-3131
  • Fax:
Mailing address:
  • Phone: 207-610-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN30366
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: