Provider Demographics
NPI:1811609233
Name:TYLER, DANIELLE ROYAL (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROYAL
Last Name:TYLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E STONE AVE APT 529
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2268
Mailing Address - Country:US
Mailing Address - Phone:404-293-4545
Mailing Address - Fax:
Practice Address - Street 1:503 E STONE AVE APT 529
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2268
Practice Address - Country:US
Practice Address - Phone:404-293-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant