Healthcare Provider Details

I. General information

NPI: 1861647190
Provider Name (Legal Business Name): LILLIAN J ZODA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 118TH AVE N
ST PETERSBURG FL
33716-2332
US

IV. Provider business mailing address

2915 44TH CT E
PALMETTO FL
34221-2206
US

V. Phone/Fax

Practice location:
  • Phone: 888-366-6243
  • Fax: 866-907-4842
Mailing address:
  • Phone: 914-466-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number212391
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: