Healthcare Provider Details

I. General information

NPI: 1134051568
Provider Name (Legal Business Name): LILY BARTON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 BASS PL N
JACKSONVILLE FL
32210-6000
US

IV. Provider business mailing address

4443 BASS PL N
JACKSONVILLE FL
32210-6000
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: