Healthcare Provider Details

I. General information

NPI: 1881772119
Provider Name (Legal Business Name): THERESA ANN LYLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA ANN LYLES-JONES RN

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 HELM CT #106
LANTANA FL
33462-0918
US

IV. Provider business mailing address

2845 HELM CT #106
LANTANA FL
33462-0918
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-1792
  • Fax:
Mailing address:
  • Phone: 561-317-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN 2862012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: