Provider Demographics
NPI:1730836404
Name:GRIMES, TYLER SUZANNE (PPD, NCS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SUZANNE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PPD, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2042
Mailing Address - Country:US
Mailing Address - Phone:954-802-2285
Mailing Address - Fax:
Practice Address - Street 1:43 WARNER ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2042
Practice Address - Country:US
Practice Address - Phone:954-802-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker