Provider Demographics
NPI:1710311527
Name:TYLER, JULIA D'LAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:D'LAINE
Last Name:TYLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:106 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3000
Practice Address - Country:US
Practice Address - Phone:713-442-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08621363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361529602Medicaid
TX361529603Medicaid
TX8KC324OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX777497OtherMEDICARE EMPLOYER PTAN - USP
TX881817OtherMEDICARE EMPLOYER PTAN - USA
TX8KA743OtherBCBS - XCITE SURGICAL
TXPA08621OtherTEXAS MEDICAL BOARD