Healthcare Provider Details

I. General information

NPI: 1992257919
Provider Name (Legal Business Name): LILLIAN MARY CATHERINE LIENHARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 INNOVATION DR STE 100
NAPLES FL
34108-2272
US

IV. Provider business mailing address

1284 INNOVATION DR
NAPLES FL
34108-2271
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-1488
  • Fax: 239-591-2491
Mailing address:
  • Phone: 239-591-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: