Provider Demographics
NPI:1174256044
Name:GJESDAHL, TYLER (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GJESDAHL
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL STE 106
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5432
Mailing Address - Country:US
Mailing Address - Phone:407-303-4829
Mailing Address - Fax:407-303-4851
Practice Address - Street 1:410 CELEBRATION PL STE 106
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5432
Practice Address - Country:US
Practice Address - Phone:407-303-4829
Practice Address - Fax:407-303-4851
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020560363LF0000X
FLAPRN11020560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily