Provider Demographics
NPI:1346757168
Name:TYLER, MARCIANA CASTILLO (MSN AGNP-C)
Entity Type:Individual
Prefix:
First Name:MARCIANA
Middle Name:CASTILLO
Last Name:TYLER
Suffix:
Gender:F
Credentials:MSN AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1841
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:137 N LHS DR STE B
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8620
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6946
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134015363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381624101Medicaid