Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tyler Clack, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1891407136

Tyler Clack, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Traverse City, Michigan. Qualified in 2022, 4 years ago. Practices with Munson Medical Group, a 189-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
4
Licensed in
MI
In the registry since
2022
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

1105 6th St
Traverse City, MI 49684-2345
Phone: (231) 935-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704339380 (MI)

Record details

NPI number1891407136
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorYes
NPI enumeratedDecember 19, 2022
Last updated in NPPESDecember 19, 2022
Certification dateDecember 14, 2022
Mailing address1105 6th St, Traverse City, MI 49684-2345

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Munson Medical Group — 189 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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