Provider Demographics
NPI:1649661935
Name:FAYIZ, LAYLA (PA-C)
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:FAYIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10970 CROSS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-4034
Mailing Address - Country:US
Mailing Address - Phone:813-369-5969
Mailing Address - Fax:
Practice Address - Street 1:10970 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-4034
Practice Address - Country:US
Practice Address - Phone:813-369-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant