Provider Demographics
NPI:1508352915
Name:EGAN, TYLER GREG (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:GREG
Last Name:EGAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:130 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2404
Practice Address - Country:US
Practice Address - Phone:352-528-5801
Practice Address - Fax:352-528-6019
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-05-16
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant