Provider Demographics
NPI:1831824366
Name:SUTTON, TYLER JON (NP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JON
Last Name:SUTTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1450
Mailing Address - Country:US
Mailing Address - Phone:801-696-4551
Mailing Address - Fax:
Practice Address - Street 1:1405 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1450
Practice Address - Country:US
Practice Address - Phone:801-696-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60927034163W00000X
WAAP61366229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse