Nicolas Lyde, PA
Physician Assistant in South Pasadena, FL. Individual provider (NPI-1).
NPI number1104986355
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1104986355
- Entity type
- Individual (NPI-1)
- Name
- Nicolas Lyde
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 11, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA3024 | FL | Yes |
Practice location
1501 Pasadena Ave SSouth Pasadena, FL 33707-3717
Phone 727-341-7777
Mailing address
861 Sw 78th AveSuite # 100b
Plantation, FL 33324-3273
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