Healthcare Provider Details

I. General information

NPI: 1043040827
Provider Name (Legal Business Name): LINDA CAROL TYLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 AVON ST STE 103
FAYETTEVILLE NC
28304-4423
US

IV. Provider business mailing address

1315 AVON ST STE 103
FAYETTEVILLE NC
28304-4423
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-8718
  • Fax: 910-703-8721
Mailing address:
  • Phone: 910-703-8718
  • Fax: 910-703-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020552
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: