Provider Demographics
NPI:1992397905
Name:TYLER, MARIE NICOLE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NICOLE
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:NICOLE
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24397
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-4397
Mailing Address - Country:US
Mailing Address - Phone:805-586-9900
Mailing Address - Fax:
Practice Address - Street 1:2697 SAVIERS ROAD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-586-9900
Practice Address - Fax:805-702-2777
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator