Healthcare Provider Details

I. General information

NPI: 1629651385
Provider Name (Legal Business Name): TYLER PATRICK ANDERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HOSPITAL RD
SYLVA NC
28779-2722
US

IV. Provider business mailing address

76 PEACHTREE RD STE 300
ASHEVILLE NC
28803-3505
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-7158
  • Fax:
Mailing address:
  • Phone: 828-398-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6615
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: