Provider Demographics
NPI:1427117845
Name:TYLER EVANS, MARCIA ELLEN (MSN PHD RN FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ELLEN
Last Name:TYLER EVANS
Suffix:
Gender:F
Credentials:MSN PHD RN FNP-BC
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Mailing Address - Street 1:2130 HERITAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7800
Mailing Address - Country:US
Mailing Address - Phone:805-296-7819
Mailing Address - Fax:805-239-1278
Practice Address - Street 1:2130 HERITAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7800
Practice Address - Country:US
Practice Address - Phone:805-296-7819
Practice Address - Fax:805-239-1278
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CA16600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235423OtherMEDICARE ID