Provider Demographics
NPI:1215695564
Name:CARRICK, TYLER (PA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CARRICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2520
Mailing Address - Country:US
Mailing Address - Phone:516-477-4303
Mailing Address - Fax:
Practice Address - Street 1:81 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-2520
Practice Address - Country:US
Practice Address - Phone:516-477-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant