1023003829 NPI number — MRS. ANN ELIZABETH TYRRELL ANP

Table of content: MRS. ANN ELIZABETH TYRRELL ANP (NPI 1023003829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023003829 NPI number — MRS. ANN ELIZABETH TYRRELL ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYRRELL
Provider First Name:
ANN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023003829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75030-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-227-2457
Provider Business Mailing Address Fax Number:
214-764-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10959 W YUKON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85373-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-227-2457
Provider Business Practice Location Address Fax Number:
214-764-0880
Provider Enumeration Date:
09/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP7139 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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