MEDICARE: LILY MALTEZOS PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11042389	FL

General Provider Information

NPI Number	:	1265304190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY MALTEZOS PMHNP

Provider Business Mailing Address
First Line	:	5325 E STATE ROAD 64 STE B
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-5534
Country	:	US
Telephone Number	:	941-277-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 16TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33705-1211
Country	:	US
Telephone Number	:	727-390-9012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	05/18/2026

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