Provider Demographics
NPI:1023549516
Name:TYLER, MEGAN CALABRESE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CALABRESE
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3475
Mailing Address - Country:US
Mailing Address - Phone:813-250-2506
Mailing Address - Fax:
Practice Address - Street 1:17 DAVIS BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3475
Practice Address - Country:US
Practice Address - Phone:813-627-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME114061207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program