Provider Demographics
NPI:1104473792
Name:SUTTON, TYLER-LAWRENCE E
Entity type:Individual
Prefix:
First Name:TYLER-LAWRENCE
Middle Name:E
Last Name:SUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2408
Mailing Address - Country:US
Mailing Address - Phone:813-534-2589
Mailing Address - Fax:
Practice Address - Street 1:18288 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4400
Practice Address - Country:US
Practice Address - Phone:813-406-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician