Provider Demographics
NPI:1336153386
Name:DEWHURST, TYLER T (APRN)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:T
Last Name:DEWHURST
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TWIN MOUNTAIN
Mailing Address - State:NH
Mailing Address - Zip Code:03595
Mailing Address - Country:US
Mailing Address - Phone:603-915-3396
Mailing Address - Fax:
Practice Address - Street 1:216 HEMLOCK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-9606
Practice Address - Country:US
Practice Address - Phone:860-471-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3829363L00000X, 363LF0000X
FLARNP3124292363L00000X
CT003829363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care