Individual
MS. TYLISA DUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
14300 GALLANT FOX LN STE 110, BOWIE, MD 20715-4031
(240) 320-7258
Mailing address
46093 SALTMARSH CT, LEXINGTON PARK, MD 20653-2879
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R240431
MD
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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