Healthcare Provider Details

I. General information

NPI: 1336057330
Provider Name (Legal Business Name): RACHAEL ALEXA LILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

101 CLEAR BROOK CT
SOUTHLAKE TX
76092-5871
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-6000
  • Fax:
Mailing address:
  • Phone: 817-908-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: