Provider Demographics
NPI:1245664184
Name:WARNECKE, TYLER LYLE (PA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LYLE
Last Name:WARNECKE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-435-7612
Practice Address - Fax:260-479-4618
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2020-09-30
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Provider Licenses
StateLicense IDTaxonomies
IN10001793A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant