Healthcare Provider Details

I. General information

NPI: 1134976418
Provider Name (Legal Business Name): LILINE HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13424 FORT KING RD
DADE CITY FL
33525-5214
US

IV. Provider business mailing address

13424 FORT KING RD
DADE CITY FL
33525-5214
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-3559
  • Fax:
Mailing address:
  • Phone: 352-347-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: