Provider Demographics
NPI:1043031453
Name:HANSON, TYLER LYALL (PA-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LYALL
Last Name:HANSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N US HWY 441 STE 601
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3003
Mailing Address - Country:US
Mailing Address - Phone:352-633-0473
Mailing Address - Fax:
Practice Address - Street 1:929 NORTH US HWY 441/27
Practice Address - Street 2:SUITE 601
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-633-0473
Practice Address - Fax:866-208-9972
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical