Healthcare Provider Details

I. General information

NPI: 1265275069
Provider Name (Legal Business Name): CARRIE TYLER MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1020
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1020
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2840
  • Fax:
Mailing address:
  • Phone: 336-832-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025286
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number319333
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: