Healthcare Provider Details

I. General information

NPI: 1386583029
Provider Name (Legal Business Name): CAROLINE LILLICRAF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST FL 4
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

233 50TH AVE APT W916
LONG ISLAND CITY NY
11101-1766
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-5558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: