MEDICARE: SUSAN TYLER NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	71014606A	IN

General Provider Information

NPI Number	:	1205601416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN TYLER NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	7230 ARBUCKLE COMMONS
Second Line	:	178
City	:	BROWNSBURG
State	:	IN
Zip	:	46112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 ARBUCKLE CMNS # 178
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-1791
Country	:	US
Telephone Number	:	317-456-2764
Fax Number	:

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

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	11/17/2023

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