Provider Demographics
NPI:1417564998
Name:TYSKOWSKI, EMILY F
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:F
Last Name:TYSKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:F
Other - Last Name:TYSKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:198 ARORA BLVD APT 3106
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3288
Mailing Address - Country:US
Mailing Address - Phone:386-264-0491
Mailing Address - Fax:
Practice Address - Street 1:515 PALM COAST PKWY SW STE 6
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-5700
Practice Address - Country:US
Practice Address - Phone:386-951-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst