MEDICARE: DR. TYLER MATTINGLY DO

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	207L00000X	Anesthesiology Physician	OS20033	FL

General Provider Information

NPI Number	:	1710482336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER MATTINGLY DO

Provider Business Mailing Address
First Line	:	705 WELLS RD STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2982
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	463386 STATE ROAD 200 UNIT A
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-3240
Country	:	US
Telephone Number	:	904-406-3888
Fax Number	:

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	05/08/2023

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Directions to “ DR. TYLER MATTINGLY DO” Practice Location

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