Healthcare Provider Details

I. General information

NPI: 1285335018
Provider Name (Legal Business Name): TYLER JAMES OSTLUND FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 110
VINEYARD UT
84059-7509
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-666-9600
  • Fax: 385-666-9601
Mailing address:
  • Phone: 435-215-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11703146-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: