Provider Demographics
NPI:1538793039
Name:TYMTSYAS, LYUDMYLA (APRN)
Entity type:Individual
Prefix:
First Name:LYUDMYLA
Middle Name:
Last Name:TYMTSYAS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E COMMERCIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3746
Mailing Address - Country:US
Mailing Address - Phone:954-542-3500
Mailing Address - Fax:954-351-5836
Practice Address - Street 1:1900 E COMMERCIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3746
Practice Address - Country:US
Practice Address - Phone:954-542-3500
Practice Address - Fax:954-351-5836
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily