Provider Demographics
NPI:1033674247
Name:TYLER, PRISCILLA KORTO A (CRNP-PC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:KORTO A
Last Name:TYLER
Suffix:
Gender:F
Credentials:CRNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6755
Mailing Address - Country:US
Mailing Address - Phone:267-401-4424
Mailing Address - Fax:
Practice Address - Street 1:2509 GROVE LN
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6755
Practice Address - Country:US
Practice Address - Phone:267-401-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics