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General NPI Number Information
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NPI Number | 1851954242
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Entity Type | Individual
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Provider Name | TYLER JON LONG DO
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Gender | Male
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 3614 KIESSEL RD
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City | THE VILLAGES
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State | FL
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Zip | 32163-2910
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Country | US
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Telephone | 352-914-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 3614 KIESSEL RD
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City | THE VILLAGES
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State | FL
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Zip | 32163-2910
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Country | US
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Telephone | 352-914-3451
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MB12236700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 21531
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 21531
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0116034370
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 21531
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License Number State | FL
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