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General NPI Number Information
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NPI Number | 1609538412
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Entity Type | Individual
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Provider Name | AMANDA ROSE TYLER ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 1594 FREEDOM BLVD STE 100C
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City | FLORENCE
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State | SC
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Zip | 29505-6046
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Country | US
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Telephone | 843-674-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 970 CARDINAL CIR
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City | FLORENCE
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State | SC
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Zip | 29505-3014
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Country | US
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Telephone | 843-615-3700
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 25169
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License Number State | SC
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