Provider Demographics
NPI:1982001418
Name:TYL, AGNIESZKA (PA-A)
Entity type:Individual
Prefix:MS
First Name:AGNIESZKA
Middle Name:
Last Name:TYL
Suffix:
Gender:F
Credentials:PA-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 S CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2235
Mailing Address - Country:US
Mailing Address - Phone:303-721-7330
Mailing Address - Fax:720-488-6566
Practice Address - Street 1:1360 S CLARKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2235
Practice Address - Country:US
Practice Address - Phone:303-721-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004173363A00000X
WAPA60805210363AM0700X
IL085007428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical