Healthcare Provider Details

I. General information

NPI: 1588269732
Provider Name (Legal Business Name): MONIKA LILO LYNN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N ROSEMONT BLVD UNIT B
TUCSON AZ
85712-2159
US

IV. Provider business mailing address

4801 E BROADWAY BLVD STE 251
TUCSON AZ
85711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 520-367-4299
  • Fax:
Mailing address:
  • Phone: 520-327-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number239547
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number239547
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number239547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: