Provider Demographics
NPI:1134644487
Name:WINDSOR, TYLER BROOKS (CRNP)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:BROOKS
Last Name:WINDSOR
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W BALDWIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3359
Mailing Address - Country:US
Mailing Address - Phone:850-769-0329
Mailing Address - Fax:844-212-7396
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:844-212-7396
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140375363L00000X, 363LF0000X
FLAPRN9486854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9486854OtherFLORIDA MEDICAL LICENSE
ALAPRN9486854OtherDEPARTMENT OF HEALTH