Healthcare Provider Details

I. General information

NPI: 1588055719
Provider Name (Legal Business Name): LILIETH J INNIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PACIFIC AVE STE C6
TACOMA WA
98402-4393
US

IV. Provider business mailing address

8195 BELVEDERE RD APT. 201
WEST PALM BEACH FL
33411-6235
US

V. Phone/Fax

Practice location:
  • Phone: 557-229-7008
  • Fax:
Mailing address:
  • Phone: 609-332-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9398858
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60886780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: