Most Relevant Information
Provider Data
| NPI Number: | 1003596263 |
| Provider Name: | TYLER JAMES RAFFERTY FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209027848 |
Most Important Dates
| Enumeration Date: | 07/24/2023 |
| Last Updated: | 09/12/2023 |
Provider Practice Location
5666 E STATE ST
ROCKFORD
IL
611082425
Practice Location Phone/Fax
| Phone: | 8152262000 |
| Fax: |
Provider Mailing Location
3739 W CEDARVILLE RD
FREEPORT
IL
610328533
Provider Mailing Phone/Fax
| Phone: | 8157213796 |
| Fax: |