Provider Demographics
NPI:1699385872
Name:LYNAM, TAZIALYNN LEILANI (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAZIALYNN
Middle Name:LEILANI
Last Name:LYNAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAZIALYNN
Other - Middle Name:LEILANI
Other - Last Name:HEGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:254 KAUMANA DR
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1941
Mailing Address - Country:US
Mailing Address - Phone:808-464-9795
Mailing Address - Fax:
Practice Address - Street 1:670 PONAHAWAI ST STE 206
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7830
Practice Address - Country:US
Practice Address - Phone:808-333-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI84575163W00000X
HIAPRN-3022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse