Tyler Douglas Hickerson, CNIM

Primary specialty

Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X

License

3216

Practice address

127 W Fairbanks Ave # 180
Winter Park, FL 32789-4326

Phone

(239) 443-8739

NPI assigned

Mar 8, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1861994584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W FAIRBANKS AVE # 180",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W FAIRBANKS AVE # 180",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894326",
            "telephone_number": "239-443-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKERSON",
        "first_name": "TYLER",
        "middle_name": "DOUGLAS",
        "credential": "CNIM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": "3216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Kelland Herschel, M.D.
• Margaret Hervey
• Megan Hession, LMHC
• Denise Hester
• Hibiscus Oaks, LLC
• Mackenzie Alexandra Hicks Harwood, MA
• Kailey Hicks
• Jorge Hidalgo, LCSW
• Marjorie Rene Hider, LMHC
• Billy D Higginbotham, PT

• Electroneurodiagnostic Specialist/Technologist in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Electroneurodiagnostic Specialist/Technologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; 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.