Provider Demographics
NPI:1508943846
Name:FREE, TYLER C (ARNP)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:C
Last Name:FREE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 116 AVE NE
Mailing Address - Street 2:102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-5311
Mailing Address - Fax:425-454-8188
Practice Address - Street 1:1600 116 AVE NE
Practice Address - Street 2:102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-5311
Practice Address - Fax:425-454-8188
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00156443163W00000X
WAAP30007152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse