Provider Demographics
NPI:1851406953
Name:LYLE, TERESA A (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:LYLE
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 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-268-7850
Mailing Address - Fax:
Practice Address - Street 1:109 W WALL ST
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843-2043
Practice Address - Country:US
Practice Address - Phone:863-635-4891
Practice Address - Fax:863-635-3545
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9367310363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ19825002Medicare UPIN