Provider Demographics
NPI:1679347546
Name:COAKLEY, TYLER ANDREW (FNP-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ANDREW
Last Name:COAKLEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 WHITEFORD RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFORD
Mailing Address - State:MD
Mailing Address - Zip Code:21160-1403
Mailing Address - Country:US
Mailing Address - Phone:443-655-6076
Mailing Address - Fax:
Practice Address - Street 1:2 COLGATE DR STE 103
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2623
Practice Address - Country:US
Practice Address - Phone:410-420-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223324363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care