Healthcare Provider Details

I. General information

NPI: 1376948281
Provider Name (Legal Business Name): CARLY BREEZE TYLER C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD SUITE 101
NEWPORT NEWS VA
23606-4434
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 101
NEWPORT NEWS VA
23606-4434
US

V. Phone/Fax

Practice location:
  • Phone: 757-223-9794
  • Fax:
Mailing address:
  • Phone: 757-223-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM2351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: