MEDICARE: MRS. VICTORIA A TYNAN NP

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	363LA2200X	Adult Health Nurse Practitioner	14662	CA
2	363LF0000X	Family Nurse Practitioner	AP3947	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891773164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA A TYNAN NP

Provider Business Mailing Address
First Line	:	6700 S LYON DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-4276
Country	:	US
Telephone Number	:	928-581-9684
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 S LYON DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-4276
Country	:	US
Telephone Number	:	928-581-9684
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	09/25/2025

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