Healthcare Provider Details

I. General information

NPI: 1841905353
Provider Name (Legal Business Name): LILLIANNE NASSAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 TURKEY LAKE RD
ORLANDO FL
32819-8015
US

IV. Provider business mailing address

200 SAINT ANDREWS BLVD APT 1203
WINTER PARK FL
32792-4230
US

V. Phone/Fax

Practice location:
  • Phone: 800-827-7546
  • Fax:
Mailing address:
  • Phone: 407-718-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: