MEDICARE: LATASHA TYLER

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	163W00000X	Registered Nurse	821712	TX

General Provider Information

NPI Number	:	1578123410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA TYLER

Provider Business Mailing Address
First Line	:	2333 WHITNEY LN
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0598
Country	:	US
Telephone Number	:	469-247-4315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 WHITNEY LN
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0598
Country	:	US
Telephone Number	:	469-247-4315
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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