Provider Demographics
NPI:1275869497
Name:NORTON, TYSEN N (PA)
Entity Type:Individual
Prefix:
First Name:TYSEN
Middle Name:N
Last Name:NORTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2559
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94927-2559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6580 HEMBREE LN STE 270
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6885
Practice Address - Country:US
Practice Address - Phone:707-838-2044
Practice Address - Fax:707-838-2150
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA53683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant