Provider Demographics
NPI:1821607813
Name:LYLAND, AUDREY ELIZABETH
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:LYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ELIZABETH
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6950 E GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1017
Mailing Address - Country:US
Mailing Address - Phone:520-309-2289
Mailing Address - Fax:
Practice Address - Street 1:6950 E GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1017
Practice Address - Country:US
Practice Address - Phone:520-309-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ244837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily