Provider Demographics
NPI:1205183423
Name:HYDE, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:HYDE
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 1:419 N. SEMINARY STREET
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-766-8667
Mailing Address - Fax:
Practice Address - Street 1:416 N SEMINARY ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4688
Practice Address - Country:US
Practice Address - Phone:256-766-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily