MEDICARE: GINA TYTULA CNM

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	367A00000X	Advanced Practice Midwife	636	CT
2	367A00000X	Advanced Practice Midwife	RN2308232	MA

General Provider Information

NPI Number	:	1134765225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA TYTULA CNM

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST FL 2
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 MAIN ST STE 4D
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1112
Country	:	US
Telephone Number	:	413-794-8336
Fax Number	:

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

Provider Enumeration Date	:	11/23/2019
Last Update Date	:	06/02/2026

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