| Lillian Ingram | |
|
1211 Tech Blvd Ste 105 Tampa FL 33619-7846 | |
| (813) 999-1516 | |
| (813) 336-8384 |
| Full Name | Lillian Ingram |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1211 Tech Blvd Ste 105, Tampa, Florida |
| Authorized Official Name and Position | Lillian E Ingram (OWNER/OPERATOR) |
| Authorized Official Contact | 6082176108 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lillian Ingram 1211 Tech Blvd Ste 105 Tampa FL 33619-7846 Ph: (813) 999-1516 | Lillian Ingram 1211 Tech Blvd Ste 105 Tampa FL 33619-7846 Ph: (813) 999-1516 |
| NPI Number | 1578146171 |
|---|---|
| Provider Enumeration Date | 04/30/2021 |
| Last Update Date | 02/16/2022 |
| Certification Date | 02/16/2022 |
| Medicare PECOS PAC ID | 7113311473 |
|---|---|
| Medicare Enrollment ID | O20220302001658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578146171 | NPI | - | NPPES |
| Provider Name | Lillian Ingram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942564711 PECOS PAC ID: 1759520349 Enrollment ID: I20130611000518 |
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