Provider Demographics
NPI:1164980017
Name:TYSON, DEBORAH ANN (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:TYSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 HOUGH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1747
Mailing Address - Country:US
Mailing Address - Phone:256-767-3330
Mailing Address - Fax:
Practice Address - Street 1:2628 HOUGH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1747
Practice Address - Country:US
Practice Address - Phone:256-767-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118983363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health