Provider Demographics
NPI:1629000922
Name:TYLER, GRETCHEN CHAPMAN (PHD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:CHAPMAN
Last Name:TYLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-1000
Mailing Address - Country:US
Mailing Address - Phone:850-912-2317
Mailing Address - Fax:850-912-2436
Practice Address - Street 1:790 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1000
Practice Address - Country:US
Practice Address - Phone:850-912-2317
Practice Address - Fax:850-912-2436
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54072WMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
FL54072WMedicare UPIN