=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124223581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYLER CHARLES ENSLEY D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2007
-----------------------------------------------------
Last Update Date | 12/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAPE CORAL HOSPITAL 636 DEL PRADO BLVD
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-424-3513
-----------------------------------------------------
Fax | 239-424-4039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 151368 CAPE CORAL EMERGENCY PHYSICIANS, LLC
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-424-3513
-----------------------------------------------------
Fax | 239-424-4039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | OS15967
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------