Provider Demographics
NPI:1659449817
Name:DYALS, PENNELOPE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNELOPE
Middle Name:
Last Name:DYALS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 OLD CAMP RD STE 144
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5609
Mailing Address - Country:US
Mailing Address - Phone:352-753-2224
Mailing Address - Fax:352-753-0833
Practice Address - Street 1:910 OLD CAMP RD STE 144
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5609
Practice Address - Country:US
Practice Address - Phone:352-753-2224
Practice Address - Fax:352-753-0833
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9309664363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology