Provider Demographics
NPI:1134700891
Name:LYDAY, JAYME NICHOLE
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:NICHOLE
Last Name:LYDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 REISSWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1268
Mailing Address - Country:US
Mailing Address - Phone:720-253-9859
Mailing Address - Fax:
Practice Address - Street 1:1950 ARLINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3516
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9561066163WL0100X
FLAPRN11013013367A00000X, 367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant