Healthcare Provider Details

I. General information

NPI: 1548066137
Provider Name (Legal Business Name): HAYLEE INTISO-LENO AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 48TH AVE N STE 200
MYRTLE BEACH SC
29577-5425
US

IV. Provider business mailing address

4059 SYLVAN LP
MYRTLE BEACH SC
29588-3008
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-1151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.29774.RX
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: