Provider Demographics
NPI:1154176766
Name:DUDEK, TYLAN MILAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TYLAN
Middle Name:MILAN
Last Name:DUDEK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WINDY RUSH CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-4196
Mailing Address - Country:US
Mailing Address - Phone:719-778-3301
Mailing Address - Fax:
Practice Address - Street 1:124 WINDY RUSH CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-4196
Practice Address - Country:US
Practice Address - Phone:719-778-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDUDE-TOPXZ363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty