Provider Demographics
NPI:1982050381
Name:HYLAND, LORRA LEECY (CRNP)
Entity Type:Individual
Prefix:
First Name:LORRA
Middle Name:LEECY
Last Name:HYLAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 OAK TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4515
Mailing Address - Country:US
Mailing Address - Phone:305-785-3484
Mailing Address - Fax:
Practice Address - Street 1:1424 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2208
Practice Address - Country:US
Practice Address - Phone:205-956-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131139363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology