Provider Demographics
NPI:1457138489
Name:NOLF, TYLER WYATT (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:WYATT
Last Name:NOLF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 COLE RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9537
Mailing Address - Country:US
Mailing Address - Phone:724-841-5012
Mailing Address - Fax:
Practice Address - Street 1:127 ONEIDA VALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2239
Practice Address - Country:US
Practice Address - Phone:844-282-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064910363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty