Healthcare Provider Details

I. General information

NPI: 1841105285
Provider Name (Legal Business Name): LILLIAN LABOUEF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 COGAN DR SE
PALM BAY FL
32909-6869
US

IV. Provider business mailing address

PO BOX 361095
MELBOURNE FL
32936-1095
US

V. Phone/Fax

Practice location:
  • Phone: 321-462-4001
  • Fax: 321-622-6400
Mailing address:
  • Phone: 321-253-2900
  • Fax: 321-435-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: