Provider Demographics
NPI:1326101932
Name:HANISCH, TYKE CHERYLLYNN (RN, MS, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TYKE
Middle Name:CHERYLLYNN
Last Name:HANISCH
Suffix:
Gender:F
Credentials:RN, MS, FNP-C
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Mailing Address - Street 1:2322 S ROGERS
Mailing Address - Street 2:UNIT # 11
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6562
Mailing Address - Country:US
Mailing Address - Phone:480-839-4486
Mailing Address - Fax:480-839-4486
Practice Address - Street 1:2150 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4814
Practice Address - Country:US
Practice Address - Phone:480-350-5878
Practice Address - Fax:480-350-5865
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23853Medicare UPIN