Healthcare Provider Details

I. General information

NPI: 1720625213
Provider Name (Legal Business Name): ANGELA DIAHANN TYLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 6TH ST
SNYDER TX
79549-8422
US

IV. Provider business mailing address

1912 6TH ST
SNYDER TX
79549-8422
US

V. Phone/Fax

Practice location:
  • Phone: 325-335-1444
  • Fax: 325-400-2939
Mailing address:
  • Phone: 325-335-1444
  • Fax: 325-400-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: