Healthcare Provider Details

I. General information

NPI: 1851970784
Provider Name (Legal Business Name): ALANA LOUISE LILLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALANA LOUISE HEARN

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E REDSTONE AVE STE 105
CRESTVIEW FL
32539-5355
US

IV. Provider business mailing address

723 16TH AVE N
CLANTON AL
35045-2101
US

V. Phone/Fax

Practice location:
  • Phone: 850-306-2751
  • Fax:
Mailing address:
  • Phone: 850-257-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS20556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: