Healthcare Provider Details

I. General information

NPI: 1164072922
Provider Name (Legal Business Name): MICHELLE LEEANN HYLAND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

151 N NOB HILL RD
PLANTATION FL
33324-1708
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7070
  • Fax: 415-353-7050
Mailing address:
  • Phone: 561-549-9090
  • Fax: 954-353-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112696
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66842
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9112696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: