MEDICARE: DIANE ORBISON TYLER RN, PHD, FNP

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	249401	TX

General Provider Information

NPI Number	:	1306823174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ORBISON TYLER RN, PHD, FNP

Provider Business Mailing Address
First Line	:	6803 W COURTYARD DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-5015
Country	:	US
Telephone Number	:	512-794-0509
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 FM 973
Second Line	:
City	:	DEL VALLE
State	:	TX
Zip	:	78617-3600
Country	:	US
Telephone Number	:	512-386-3335
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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