MEDICARE: TYSON ANDES

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	163WG0000X	General Practice Registered Nurse	293373	AZ

General Provider Information

NPI Number	:	1376479097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSON ANDES

Provider Business Mailing Address
First Line	:	22655 E ESTRELLA RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2002
Country	:	US
Telephone Number	:	480-540-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	22655 E ESTRELLA RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-2002
Country	:	US
Telephone Number	:	480-540-6183
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ TYSON ANDES ” Practice Location

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