Provider Demographics
NPI:1083224026
Name:RODRIGUEZ, TYLER (LVN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 STONE CANYON RD APT 1157
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4360
Mailing Address - Country:US
Mailing Address - Phone:254-718-1742
Mailing Address - Fax:
Practice Address - Street 1:10814 STONE CANYON RD APT 1157
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4360
Practice Address - Country:US
Practice Address - Phone:254-718-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336358164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX336358Medicaid