Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 005499 | CT |
NPI | 1003241100 |
---|---|
Provider Name | Ms. Sarah Louise Tyler |
First Address | East Lyme, CT 06333-1735 |
Second Address | East Lyme, CT 06333-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2013 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004217099 | PCS MEDICAID LW (01) | CT |
008039745 | PCS MEDICAID (BPT) (01) | CT |
008056033 | PCS MEDICAID CONGRESS (01) | CT |
008056168 | MEDICAID 352 STATE STREET (01) | CT |
008056867 | HOAGLAND MEDICAID # (01) | CT |
WEAZY13 | HOAGLAND SARAH APRN MEDICARE (01) | CT |