Tyson Andes

Individual provider Active NPI General Practice Registered Nurse · Queen Creek, AZ

NPI 1376479097 · NPPES record last updated Jun 22, 2026

Key facts

NPI
1376479097
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Registered Nurse 163WG0000X
License
293373 (AZ)
Practice address
22655 E Estrella Rd
Queen Creek, AZ 85142-2002
Phone
(480) 540-6183
NPI assigned
Jun 22, 2026
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 293373 AZ Yes

Addresses

Primary practice location

22655 E Estrella Rd
Queen Creek, AZ 85142-2002

Mailing address

22655 E Estrella Rd
Queen Creek, AZ 85142-2002
Phone (480) 540-6183

Other providers in Queen Creek, AZ

All providers in Queen Creek, AZ · General Practice Registered Nurse in Arizona

Sources for this page

Verify at the official NPI Registry.