Provider Demographics
NPI:1154195923
Name:MARIAGE, TYLER JAMES (FNP-BC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:MARIAGE
Suffix:
Gender:
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 1:17000 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1263
Mailing Address - Country:US
Mailing Address - Phone:586-563-5555
Mailing Address - Fax:586-563-1778
Practice Address - Street 1:17000 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1263
Practice Address - Country:US
Practice Address - Phone:586-563-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI34704346298363LF0000X
MI4704346298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty