Provider Demographics
NPI:1750634648
Name:TYRE, TENISIA (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:TENISIA
Middle Name:
Last Name:TYRE
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 ZANA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-4069
Mailing Address - Country:US
Mailing Address - Phone:239-694-5876
Mailing Address - Fax:
Practice Address - Street 1:1201 WINGS WAY
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-3601
Practice Address - Country:US
Practice Address - Phone:239-333-4250
Practice Address - Fax:239-333-4251
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3421362363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health