Provider Demographics
NPI:1396097564
Name:KYLE, TALITHA (APRN)
Entity type:Individual
Prefix:MRS
First Name:TALITHA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TALITHA
Other - Middle Name:
Other - Last Name:HALLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:107 CHARLES E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2745
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014099100Medicaid
FLARNP9396343OtherSTATE LICENSE