Provider Demographics
NPI:1174930069
Name:DIAL, SKYLAR ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SKYLAR
Middle Name:ANN
Last Name:DIAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:ANN
Other - Last Name:ZINSMEISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:2200 OSPREY BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3308
Practice Address - Country:US
Practice Address - Phone:863-533-8111
Practice Address - Fax:863-519-1432
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant