Individual
TYLER LANE VAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17779 SW 2ND ST, PEMBROKE PINES, FL 33029-3924
(954) 322-1110
(954) 322-1099
Mailing address
17779 SW 2ND ST, PEMBROKE PINES, FL 33029-3924
(954) 322-1110
(954) 322-1099
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9107669
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9107669
FL
Other
Enumeration date
11/11/2013
Last updated
11/11/2013
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