Provider Demographics
NPI:1477121622
Name:NALBACH, TYLER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:NALBACH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 LIBERTY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1420
Mailing Address - Country:US
Mailing Address - Phone:607-259-9860
Mailing Address - Fax:
Practice Address - Street 1:3955 LIBERTY AVE APT 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1420
Practice Address - Country:US
Practice Address - Phone:607-259-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant