MEDICARE: TYLER DEAN MOLLET FNP-C

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	363LF0000X	Family Nurse Practitioner	0024181708	VA

General Provider Information

NPI Number	:	1124697024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER DEAN MOLLET FNP-C

Provider Business Mailing Address
First Line	:	895 CITY CENTER BLVD STE 200
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 MONROE ST STE C208
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6350
Country	:	US
Telephone Number	:	201-533-9299
Fax Number	:

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

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	04/21/2026

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