Provider Demographics
NPI:1104487164
Name:TYSZ, JESSICA ANNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:TYSZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:9000 GREENBRIER PKWY NW UNIT 84
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4815
Mailing Address - Country:US
Mailing Address - Phone:256-893-9500
Mailing Address - Fax:
Practice Address - Street 1:9000 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756
Practice Address - Country:US
Practice Address - Phone:256-893-9500
Practice Address - Fax:702-853-3854
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821593363LF0000X
AL1-193147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily