Provider Demographics
NPI:1922647577
Name:LYLES, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9136 SW 227TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1976
Mailing Address - Country:US
Mailing Address - Phone:256-453-9070
Mailing Address - Fax:
Practice Address - Street 1:9136 SW 227TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1976
Practice Address - Country:US
Practice Address - Phone:256-453-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9444722163WC0400X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No163WC0400XNursing Service ProvidersRegistered NurseCase Management