Provider Demographics
NPI:1033344643
Name:HOLLEN, TYLER ROWLAND (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ROWLAND
Last Name:HOLLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3210 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6411
Practice Address - Country:US
Practice Address - Phone:941-364-8887
Practice Address - Fax:941-954-3222
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13798207R00000X
FLME1196442085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9018898OtherCIGNA
FLP1022207OtherFREEDOM
FL1003640OtherWELLCARE
FL011994300Medicaid
FLP961503OtherOPTIMUM
FLP01343344OtherRR MEDICARE
FL011994300Medicaid