Provider Demographics
NPI:1578172490
Name:SILVA, LALY ENOE (APRN)
Entity Type:Individual
Prefix:
First Name:LALY
Middle Name:ENOE
Last Name:SILVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 BURNT MILL RD APT 513
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4672
Mailing Address - Country:US
Mailing Address - Phone:904-874-0939
Mailing Address - Fax:
Practice Address - Street 1:10961 BURNT MILL RD APT 513
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4672
Practice Address - Country:US
Practice Address - Phone:904-874-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily