Provider Demographics
NPI:1013638345
Name:JAAP, TYLER (IDHS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:JAAP
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AW WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1502
Mailing Address - Country:US
Mailing Address - Phone:901-521-4812
Mailing Address - Fax:
Practice Address - Street 1:2 AW WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1502
Practice Address - Country:US
Practice Address - Phone:901-521-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians