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General NPI Number Information
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NPI Number | 1629628896
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Entity Type | Individual
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Provider Name | TYLER ANDREW SUDDARTH
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Gender | Male
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 7700 W SUNRISE BLVD
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City | PLANTATION
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State | FL
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Zip | 33322-4113
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Country | US
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Telephone | 954-939-6852
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Fax |
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Provider Business Mailing Address
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Address Line | 302 MIDLAND PL
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City | CAIRO
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State | GA
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Zip | 39828-7604
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Country | US
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Telephone | 229-300-4938
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9394983
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11005496
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License Number State | FL
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