Provider Demographics
NPI:1720613722
Name:TYLER, ANGELA DENISE (PCA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:TYLER
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DENISE
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCA
Mailing Address - Street 1:1480 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2518
Mailing Address - Country:US
Mailing Address - Phone:614-348-6971
Mailing Address - Fax:
Practice Address - Street 1:1480 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2518
Practice Address - Country:US
Practice Address - Phone:614-348-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329790Medicaid