Provider Demographics
NPI:1871284406
Name:HOERL, JONATHAN TYLER (MSN, APNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TYLER
Last Name:HOERL
Suffix:
Gender:
Credentials:MSN, APNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2504
Mailing Address - Country:US
Mailing Address - Phone:414-427-5310
Mailing Address - Fax:414-427-5311
Practice Address - Street 1:4455 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2504
Practice Address - Country:US
Practice Address - Phone:414-427-5310
Practice Address - Fax:414-427-5311
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13932363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871284406Medicaid