Provider Demographics
NPI:1104550565
Name:MAAG, TYLER J (FNP-BC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:MAAG
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9288 SHAFFER ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-0202
Mailing Address - Country:US
Mailing Address - Phone:419-890-8840
Mailing Address - Fax:
Practice Address - Street 1:100 PROGRESSIVE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-9620
Practice Address - Country:US
Practice Address - Phone:419-659-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.439039163WC0200X
OHAPRN.CNP.0032202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine