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General NPI Number Information
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NPI Number | 1043031453
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Entity Type | Individual
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Provider Name | TYLER LYALL HANSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 929 NORTH US HWY 441/27 SUITE 601
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-633-0473
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Fax | 866-208-9972
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Provider Business Mailing Address
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Address Line | 929 N US HWY 441 STE 601
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City | LADY LAKE
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State | FL
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Zip | 32159-3003
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Country | US
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Telephone | 352-633-0473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9119365
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License Number State | FL
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