Provider Demographics
NPI:1467982678
Name:HILLIARD, TYRA
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:HILLIARD
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 1:1140 CASTLE WOOD TER APT 104
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3684
Mailing Address - Country:US
Mailing Address - Phone:727-422-9923
Mailing Address - Fax:
Practice Address - Street 1:4917 ELI ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1717
Practice Address - Country:US
Practice Address - Phone:407-808-7837
Practice Address - Fax:407-630-8805
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician