Provider Demographics
NPI:1770153900
Name:BROWN, TYLER SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:BROWN
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 1:30 RAVENWOOD DR E
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1139
Mailing Address - Country:US
Mailing Address - Phone:732-616-9195
Mailing Address - Fax:
Practice Address - Street 1:610 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3702
Practice Address - Country:US
Practice Address - Phone:570-714-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical