Provider Demographics
NPI:1013353143
Name:TYSON, YVONNE (ARNP)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 EAGLE HARBOR PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4827
Mailing Address - Country:US
Mailing Address - Phone:904-215-5262
Mailing Address - Fax:
Practice Address - Street 1:1481 HWY 40 E
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6507
Practice Address - Country:US
Practice Address - Phone:912-576-6865
Practice Address - Fax:912-576-2565
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9269854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily