Provider Demographics
NPI:1649836768
Name:TARRANT, TYLA SHERRIE'
Entity type:Individual
Prefix:
First Name:TYLA
Middle Name:SHERRIE'
Last Name:TARRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 CR 427
Mailing Address - Street 2:#502
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704
Mailing Address - Country:US
Mailing Address - Phone:903-563-0481
Mailing Address - Fax:
Practice Address - Street 1:3050 CR 427
Practice Address - Street 2:#502
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704
Practice Address - Country:US
Practice Address - Phone:903-563-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345178164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse