Individual provider Active NPI

Fabiola Tyson, FNP-C

  • Family Nurse Practitioner
  • El Centro, CA
National Provider Identifier
1518600360
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95020675 Issued in CA
Practice address
2026 N Imperial Ave Ste C
El Centro, CA 92243-1607
Phone
(760) 592-4351
NPI assigned
Apr 19, 2022
Last updated
Apr 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95020675 CA Primary

Addresses

Primary practice location

2026 N Imperial Ave Ste C
El Centro, CA 92243-1607

Mailing address

2010 Chaparral Dr
El Centro, CA 92243-6115
Phone (760) 790-7665

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL ECW

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220831003250 CA Practitioner - Nurse Practitioner 0042694580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tyson Medical IncGroup PAC ID 3072870112, 21 clinicians

Practice addresses (Care Compare)

2026 N Imperial Ave
El Centro, CA 92243-1607
Phone (760) 592-4351

2026 N Imperial Ave C
El Centro, CA 92243-1607

207 W Legion Rd
Brawley, CA 92227-7780
Phone (760) 351-3333

400 Mary Ave
Calexico, CA 92231-2875
Phone (760) 592-4351

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95020675CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tyson Medical Inc CurrentSince Jul 1, 2022 Accepting new patients
Tyson Medical Inc CurrentSince Jul 1, 2022 Accepting new patients

Locations

207 W Legion Rd
Brawley, CA 92227
Phone (760) 351-3333

630 S Brawley Ave
Ste 10
Brawley, CA 92227
Phone (760) 623-1202

400 Mary Ave
Ste 1
Calexico, CA 92231
Phone (442) 220-1550

400 Mary Ave
Ste 2
Calexico, CA 92231
Phone (760) 592-4351

400 Mary Ave
Ste A
Calexico, CA 92231

1044 Cherry Valley Blvd
#430
Calimesa, CA 92320
Phone (760) 592-4351

2026 N Imperial Ave
Ste C
El Centro, CA 92243
Phone (760) 592-4351

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1518600360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 CHAPARRAL DR",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922436115",
            "telephone_number": "760-790-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2026 N IMPERIAL AVE STE C",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922431607",
            "telephone_number": "760-592-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "FABIOLA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95020675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ECW",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "address_1": "2026 N Imperial Ave Ste C",
            "city": "El Centro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "922431607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in El Centro, CA

Sources for this page

Verify at the official NPI Registry.