Individual provider Active NPI

Tylena Anderson

  • Registered Nurse
  • Glendale, AZ
National Provider Identifier
1093595902
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
235681 Issued in AZ
Practice address
4035 W Alameda Rd
Glendale, AZ 85310-3304
Phone
(623) 445-4700
NPI assigned
Sep 29, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 235681 AZ Primary

Addresses

Primary practice location

4035 W Alameda Rd
Glendale, AZ 85310-3304

Mailing address

5803 N 71St Dr
Glendale, AZ 85303-5707
Phone (310) 251-9687

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
235681AZMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Sage Elementary CurrentSince Sep 15, 2024 Accepting new patients

Locations

4035 W Alameda Rd
Glendale, AZ 85310
Phone (623) 445-4700

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1093595902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5803 N 71ST DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853035707",
            "telephone_number": "310-251-9687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 W ALAMEDA RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853103304",
            "telephone_number": "623-445-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TYLENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "235681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.