Healthcare Provider Details

I. General information

NPI: 1801381561
Provider Name (Legal Business Name): TYLER J THOMAS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HARRISBURG AVE
LANCASTER PA
17603
US

IV. Provider business mailing address

217 HARRISBURG AVE
LANCASTER PA
17603-2964
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-8300
  • Fax: 717-544-8265
Mailing address:
  • Phone: 717-544-8300
  • Fax: 717-544-8265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN648252
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP019045
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: