Healthcare Provider Details

I. General information

NPI: 1770590127
Provider Name (Legal Business Name): JUDITH ANN LILJA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 W SUNRISE BLVD
PLANTATION FL
33313-4406
US

IV. Provider business mailing address

2112 S CYPRESS BEND DR APT 102
POMPANO BEACH FL
33069-4452
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-6200
  • Fax:
Mailing address:
  • Phone: 954-972-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3196012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: