Doctor Name: | PATRICIA A. TYRA |
NPI Number: | 1063700888 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN/PC,PMHCNS-BC |
License Number: | RN83437 |
Business Practice Address: | 111 Edgartown Road Oak Bluffs, MA - 02557 |
Business Phone Number: | 5086937900 |
Business Fax Number: | 5086960401 |
Mailing Address: | Po Box 369, VINEYARD HAVEN |
State: | MA |
Postal Code: | 025680369 |
Phone Number: | 5086937900 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2011 |
NPI Last Update Date: | 07/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0808X |
License Number: | RN83437 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |