Provider Demographics
NPI:1437845104
Name:HIJAZI, TYLER LAYNE (NP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:LAYNE
Last Name:HIJAZI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 15 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3621
Mailing Address - Country:US
Mailing Address - Phone:586-284-2643
Mailing Address - Fax:
Practice Address - Street 1:9001 15 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3621
Practice Address - Country:US
Practice Address - Phone:586-284-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704389914363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health