Provider Demographics
NPI:1467051318
Name:BOVA, TYLYN
Entity Type:Individual
Prefix:
First Name:TYLYN
Middle Name:
Last Name:BOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 ADAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2836
Mailing Address - Country:US
Mailing Address - Phone:740-891-9000
Mailing Address - Fax:740-891-9001
Practice Address - Street 1:1330 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9614
Practice Address - Country:US
Practice Address - Phone:740-421-9530
Practice Address - Fax:740-421-9531
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027383363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner