Provider Demographics
NPI:1164072922
Name:HYLAND, MICHELLE LEEANN (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEEANN
Last Name:HYLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 N OAKLAND FOREST DR APT 309
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6411
Mailing Address - Country:US
Mailing Address - Phone:407-415-9059
Mailing Address - Fax:
Practice Address - Street 1:7630 SW 34TH MNR STE 300
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1985
Practice Address - Country:US
Practice Address - Phone:954-475-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FL363AS0400X
FLPA9112696363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical