Provider Demographics
NPI:1316323751
Name:TYLUS, LISA (AGNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TYLUS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HIGH STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-685-2460
Mailing Address - Fax:
Practice Address - Street 1:47 HIGH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-685-2460
Practice Address - Fax:978-685-2572
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN270127363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner