Provider Demographics
NPI:1336827120
Name:VAN CURA, TYLER (AGACNP, RN, MSN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:VAN CURA
Suffix:
Gender:M
Credentials:AGACNP, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ERIE CRES
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2469
Mailing Address - Country:US
Mailing Address - Phone:585-749-1587
Mailing Address - Fax:
Practice Address - Street 1:3062 COUNTY COMPLEX DR # 9502
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9502
Practice Address - Country:US
Practice Address - Phone:585-396-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431995363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care