Provider Demographics
NPI:1528181088
Name:STANLEY, TYLER M (APRN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 FARMINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2139
Mailing Address - Country:US
Mailing Address - Phone:860-561-4300
Mailing Address - Fax:860-561-1635
Practice Address - Street 1:970 FARMINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2139
Practice Address - Country:US
Practice Address - Phone:860-561-4300
Practice Address - Fax:860-561-1635
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003155363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics