Healthcare Provider Details

I. General information

NPI: 1659943595
Provider Name (Legal Business Name): LILLIAN PRINE BYRD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 US HIGHWAY 27 SW
BRANFORD FL
32008-2767
US

IV. Provider business mailing address

23343 NW COUNTY ROAD 236
HIGH SPRINGS FL
32643-9669
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-3090
  • Fax: 386-935-3198
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: