Provider Demographics
NPI:1932344181
Name:BYRD, HILLARY (ARNP)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 NE COUNTY ROAD 410
Mailing Address - Street 2:
Mailing Address - City:MAYO
Mailing Address - State:FL
Mailing Address - Zip Code:32066-6117
Mailing Address - Country:US
Mailing Address - Phone:386-294-1224
Mailing Address - Fax:
Practice Address - Street 1:1113 NE COUNTY ROAD 410
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-6117
Practice Address - Country:US
Practice Address - Phone:386-294-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000935900Medicaid
BM352YOtherMEDICARE PTAN