Provider Demographics
NPI:1508851502
Name:HIGHSMITH-TYLER, AQUILLA LYNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:AQUILLA
Middle Name:LYNETTE
Last Name:HIGHSMITH-TYLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AQUILLLA
Other - Middle Name:LYNETTE
Other - Last Name:HIGHSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5406 JOSH DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2210
Mailing Address - Country:US
Mailing Address - Phone:850-883-8891
Mailing Address - Fax:850-883-2432
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5638
Practice Address - Country:US
Practice Address - Phone:210-292-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237853207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN