Provider Demographics
NPI:1790381820
Name:TYLOR, BRENDA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TYLOR
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E BAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4365
Mailing Address - Country:US
Mailing Address - Phone:480-296-4663
Mailing Address - Fax:
Practice Address - Street 1:1220 E BAYLOR CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4365
Practice Address - Country:US
Practice Address - Phone:480-296-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250556363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care