Healthcare Provider Details

I. General information

NPI: 1588291165
Provider Name (Legal Business Name): LILIT TAMAZYAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

19203 GLENMOOR DR
WEST PALM BEACH FL
33409-2787
US

V. Phone/Fax

Practice location:
  • Phone: 561-263-2234
  • Fax:
Mailing address:
  • Phone: 252-305-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: