Provider Demographics
NPI:1780174425
Name:HOWARD, TYLER JACOB
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JACOB
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 APALACHEE TRCE
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1180
Mailing Address - Country:US
Mailing Address - Phone:678-977-8748
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
NC1000-00741367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant