Provider Demographics
NPI:1881772119
Name:LYLES, THERESA ANN (RN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:LYLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:LYLES-JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2845 HELM CT
Mailing Address - Street 2:#106
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-0918
Mailing Address - Country:US
Mailing Address - Phone:561-317-1792
Mailing Address - Fax:
Practice Address - Street 1:2845 HELM CT
Practice Address - Street 2:#106
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-0918
Practice Address - Country:US
Practice Address - Phone:561-317-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 2862012163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical