Provider Demographics
NPI:1548327083
Name:TYLER, RENAY (ACNP)
Entity type:Individual
Prefix:
First Name:RENAY
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 RYEGATE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1745
Mailing Address - Country:US
Mailing Address - Phone:410-583-5299
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-502-2590
Practice Address - Fax:410-955-4870
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072779163WN1003X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care