Individual
AUDREY J TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
200 VARICK ST, NEW YORK, NY 10014-4810
(212) 620-0340
(212) 243-4868
Mailing address
1218 E 98TH ST, BROOKLYN, NY 11236-4402
(917) 445-9524
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F305729-1
NY
363LG0600X
Gerontology Nurse Practitioner
F340822-1
NY
Other
Enumeration date
05/23/2012
Last updated
05/23/2012
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