Provider Demographics
NPI:1235668153
Name:TYLER, TIA GIOVANNA (FNP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:GIOVANNA
Last Name:TYLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0015
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:1825 ROCKBRIDGE RD STE 15B
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3306
Practice Address - Country:US
Practice Address - Phone:470-444-3134
Practice Address - Fax:470-276-4370
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016289363LF0000X
GARN307702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily