Provider Demographics
NPI:1134476088
Name:HART-TYNER, CARLA VALERIE (NP-C, PMHNP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:VALERIE
Last Name:HART-TYNER
Suffix:
Gender:F
Credentials:NP-C, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WHIPPLE AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4802
Mailing Address - Country:US
Mailing Address - Phone:216-413-0413
Mailing Address - Fax:
Practice Address - Street 1:3801 WHIPPLE AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4802
Practice Address - Country:US
Practice Address - Phone:216-413-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172219363LA2200X
OHAPRN.CNP.13636363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073278Medicaid