Provider Demographics
NPI:1073935300
Name:LYLE, SARAH (PA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8194 FIERA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-5031
Mailing Address - Country:US
Mailing Address - Phone:501-388-0265
Mailing Address - Fax:
Practice Address - Street 1:8194 FIERA RIDGE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-5031
Practice Address - Country:US
Practice Address - Phone:501-388-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant