Healthcare Provider Details

I. General information

NPI: 1083288807
Provider Name (Legal Business Name): LIANN MICHELLE AMMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date: 10/31/2022
Reactivation Date: 12/20/2022

III. Provider practice location address

6440 W NEWBERRY RD STE 508
GAINESVILLE FL
32605-8303
US

IV. Provider business mailing address

6440 W NEWBERRY RD STE 508
GAINESVILLE FL
32605-8303
US

V. Phone/Fax

Practice location:
  • Phone: 352-792-6123
  • Fax:
Mailing address:
  • Phone: 352-792-6123
  • 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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME173750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: