Provider Demographics
NPI:1972299519
Name:ARMSTRONG, TYRELL A
Entity type:Individual
Prefix:
First Name:TYRELL
Middle Name:A
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13414 W INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9706
Mailing Address - Country:US
Mailing Address - Phone:701-339-2008
Mailing Address - Fax:
Practice Address - Street 1:13414 W INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9706
Practice Address - Country:US
Practice Address - Phone:701-339-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)