Provider Demographics
NPI:1922359207
Name:BYRD, MARIA LISA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LISA
Last Name:BYRD
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 1:2829 DAVID STEWART LN
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3904
Mailing Address - Country:US
Mailing Address - Phone:352-874-3219
Mailing Address - Fax:
Practice Address - Street 1:1950 LAUREL MANOR DR STE 172
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5612
Practice Address - Country:US
Practice Address - Phone:352-391-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218535363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health