Provider Demographics
NPI:1063834653
Name:HUTCHISON, TYSON (APRN)
Entity Type:Individual
Prefix:MR
First Name:TYSON
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:FELDA
Mailing Address - State:FL
Mailing Address - Zip Code:33930-0476
Mailing Address - Country:US
Mailing Address - Phone:941-264-9167
Mailing Address - Fax:
Practice Address - Street 1:10200 CYPRESS COVE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6690
Practice Address - Country:US
Practice Address - Phone:941-264-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9278598363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012641500Medicaid
FL1063834653OtherMEDICARE