Healthcare Provider Details

I. General information

NPI: 1134813710
Provider Name (Legal Business Name): TYLER DARTT PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E. DUBLIN GRANVILLE RD
COLUMBUS OH
43229-2518
US

IV. Provider business mailing address

568 PRINCETON ST
ASHVILLE OH
43103-2518
US

V. Phone/Fax

Practice location:
  • Phone: 614-953-5219
  • Fax:
Mailing address:
  • Phone: 614-400-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: