Provider Demographics
NPI:1629582317
Name:ALLISON, TYLA ALEXIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:TYLA
Middle Name:ALEXIS
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-1708
Mailing Address - Country:US
Mailing Address - Phone:585-713-8687
Mailing Address - Fax:
Practice Address - Street 1:55 MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3139
Practice Address - Country:US
Practice Address - Phone:585-698-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY741333163WH0200X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health