Provider Demographics
NPI:1225748791
Name:TYLER, OLGA B (FNP)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:B
Last Name:TYLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15713 ATKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4521
Mailing Address - Country:US
Mailing Address - Phone:310-995-2485
Mailing Address - Fax:
Practice Address - Street 1:4455 W 117TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2240
Practice Address - Country:US
Practice Address - Phone:310-219-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950223851363LP2300X
CA95023851363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care