1063834653 NPI number — MR. TYSON HUTCHISON APRN

Table of content: MR. TYSON HUTCHISON APRN (NPI 1063834653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063834653 NPI number — MR. TYSON HUTCHISON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHISON
Provider First Name:
TYSON
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1063834653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 476
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FELDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33930-0476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-264-9167
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2503 CR 830
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FELDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-744-6640
Provider Business Practice Location Address Fax Number:
877-673-2995
Provider Enumeration Date:
01/16/2014

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: 363LF0000X , with the licence number:  APRN9278598 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN9278598 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 012641500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com