Healthcare Provider Details

I. General information

NPI: 1285538082
Provider Name (Legal Business Name): TYLER LELIO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 LONGLEAF PINE PKWY STE 207
SAINT JOHNS FL
32259-7484
US

IV. Provider business mailing address

PO BOX 9065
PANAMA CITY BEACH FL
32417-9065
US

V. Phone/Fax

Practice location:
  • Phone: 904-201-3271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: