Healthcare Provider Details

I. General information

NPI: 1912695313
Provider Name (Legal Business Name): ERICA LIEBKNECHT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LOOKOUT PL STE 201
MAITLAND FL
32751-4485
US

IV. Provider business mailing address

260 LOOKOUT PL STE 201
MAITLAND FL
32751-4485
US

V. Phone/Fax

Practice location:
  • Phone: 407-440-1054
  • Fax:
Mailing address:
  • Phone: 407-440-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number9117459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: