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General NPI Number Information
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NPI Number | 1245856657
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Entity Type | Individual
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Provider Name | TYLER R TANZYUS FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD STE 102B
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2343
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Country | US
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Telephone | 314-996-7080
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Fax | 314-996-7085
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Provider Business Mailing Address
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Address Line | 660 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8512
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Country | US
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Telephone | 314-448-3791
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Fax | 314-996-7658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209023840
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2023047204
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209023840
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License Number State | IL
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