Healthcare Provider Details

I. General information

NPI: 1306823174
Provider Name (Legal Business Name): DIANE ORBISON TYLER RN, PHD, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 FM 973
DEL VALLE TX
78617-3600
US

IV. Provider business mailing address

6803 W COURTYARD DR
AUSTIN TX
78730-5015
US

V. Phone/Fax

Practice location:
  • Phone: 512-386-3335
  • Fax:
Mailing address:
  • Phone: 512-794-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number249401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: