Provider Demographics
NPI:1407722754
Name:CABRAL, TYLER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CABRAL
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 RIVER AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4723
Mailing Address - Country:US
Mailing Address - Phone:508-971-6595
Mailing Address - Fax:
Practice Address - Street 1:159 RIVER AVE APT 3C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4723
Practice Address - Country:US
Practice Address - Phone:508-971-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313443363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health