Provider Demographics
NPI:1558556449
Name:HAYES, LEILANI MELISSA (LMT; LPN)
Entity Type:Individual
Prefix:MISS
First Name:LEILANI
Middle Name:MELISSA
Last Name:HAYES
Suffix:
Gender:F
Credentials:LMT; LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 A1A S STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6523
Mailing Address - Country:US
Mailing Address - Phone:904-669-9336
Mailing Address - Fax:
Practice Address - Street 1:2180 A1A S STE 100
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:904-669-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5174052164W00000X
FL29013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse