Healthcare Provider Details

I. General information

NPI: 1851885909
Provider Name (Legal Business Name): TYLER HEGARTY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 5320
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

5681 YANKEETOWN PIKE
CIRCLEVILLE OH
43113-9698
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-1997
  • Fax:
Mailing address:
  • Phone: 614-264-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.022894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: