Provider Demographics
NPI:1194448068
Name:SKILLAN, TYLER LUKE (RN)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:LUKE
Last Name:SKILLAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 SHADETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-8554
Mailing Address - Country:US
Mailing Address - Phone:717-659-3533
Mailing Address - Fax:
Practice Address - Street 1:538 SHADETREE BLVD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-8554
Practice Address - Country:US
Practice Address - Phone:717-659-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN715195163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine