MEDICARE: LILLIAN INGRAM

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	363LF0000X	Family Nurse Practitioner	ARNP9359459	FL
2	363LF0000X	Family Nurse Practitioner	RN223698	GA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN02951	RI
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9359459	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942564711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN INGRAM

Provider Business Mailing Address
First Line	:	1211 TECH BLVD STE 105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:	813-999-1516
Fax Number	:	813-336-8384

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD STE 105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:	813-999-1516
Fax Number	:	813-336-8384

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

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	02/21/2022

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Directions to “ LILLIAN INGRAM ” Practice Location

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