Provider Demographics
NPI:1104880962
Name:TYLER, DARLENE FAY (RN, FNP)
Entity type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:FAY
Last Name:TYLER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 E LUGONIA AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2486
Mailing Address - Country:US
Mailing Address - Phone:909-798-9315
Mailing Address - Fax:
Practice Address - Street 1:545 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2101
Practice Address - Country:US
Practice Address - Phone:213-673-4849
Practice Address - Fax:213-673-4581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily