MEDICARE: TYLER JADE CARDINELL

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1194610493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JADE CARDINELL

Provider Business Mailing Address
First Line	:	3088 19TH PL SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-1437
Country	:	US
Telephone Number	:	727-580-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3088 19TH PL SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-1437
Country	:	US
Telephone Number	:	727-580-9696
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	05/07/2026

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Directions to “ TYLER JADE CARDINELL ” Practice Location

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