Provider Demographics
NPI:1932703907
Name:GILYARD, TERRY LISHONE (APRN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LISHONE
Last Name:GILYARD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-0722
Mailing Address - Country:US
Mailing Address - Phone:386-323-9600
Mailing Address - Fax:386-323-9811
Practice Address - Street 1:1455 DUNN AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5301
Practice Address - Country:US
Practice Address - Phone:386-559-7498
Practice Address - Fax:386-698-2003
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily