Provider Demographics
NPI:1376268748
Name:RAUWOLF, TYLER JONATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JONATHAN
Last Name:RAUWOLF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-4305
Mailing Address - Country:US
Mailing Address - Phone:708-363-7476
Mailing Address - Fax:
Practice Address - Street 1:4885 ANTRIM DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-4305
Practice Address - Country:US
Practice Address - Phone:708-363-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist