MEDICARE: KIMBERLY LYNN TYLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	93678	FL
2	363LF0000X	Family Nurse Practitioner	APRN11000595	FL
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F331853	NY
4	363LF0000X	Family Nurse Practitioner	APRN1100595	FL

General Provider Information

NPI Number	:	1013980432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LYNN TYLER FNP

Provider Business Mailing Address
First Line	:	2415 UNIVERSITY PKWY STE 218
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2809
Country	:	US
Telephone Number	:	941-955-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 UNIVERSITY PKWY STE 218
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2809
Country	:	US
Telephone Number	:	941-955-6220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/10/2021

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