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NPI Code Detail

MEDICARE: EMILY TYLER PA

MEDICARE: EMILY TYLER PA
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
1363A00000XPhysician Assistant271279-1206UT

General Provider Information

NPI Number : 1033285622
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY TYLER PA
Provider Business Mailing Address
First Line : 42575 WASHINGTON
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-8850
Country : US
Telephone Number : 760-360-0333
Fax Number : 760-360-1053
Provider Business Practice Location Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3500
Fax Number : 801-536-3799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 10/21/2021

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Directions to “ EMILY TYLER PA” Practice Location

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