Provider Demographics
NPI:1780299008
Name:SPEARMAN, TYLER LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LEIGH
Last Name:SPEARMAN
Suffix:
Gender:F
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 1:7777 FOREST LN STE C106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6831
Mailing Address - Country:US
Mailing Address - Phone:972-566-5255
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6831
Practice Address - Country:US
Practice Address - Phone:972-566-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX13743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant