Provider Demographics
NPI:1568972388
Name:TYSEN, CARA
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:TYSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:BEAUREGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5170 CENTRAL SARASOTA PKWY APT 308
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-7624
Mailing Address - Country:US
Mailing Address - Phone:774-239-1727
Mailing Address - Fax:
Practice Address - Street 1:6976 PROFESSIONAL PKWY E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8414
Practice Address - Country:US
Practice Address - Phone:941-308-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician