Provider Demographics
NPI:1083376578
Name:FERNANDES, TYLER JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JAMES
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHRISTOPHER COLUMBUS DR APT 3102
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5716
Mailing Address - Country:US
Mailing Address - Phone:774-254-5924
Mailing Address - Fax:
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-556-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant