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General NPI Number Information
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NPI Number | 1346222569
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Entity Type | Individual
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Provider Name | FLOR MARITZA LLISO P.A.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 5795 CARRIAGE HILLS DR
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City | AUGUSTA
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State | GA
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Zip | 30907-8208
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Country | US
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Telephone | 912-980-7342
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Fax |
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Provider Business Mailing Address
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Address Line | 5795 CARRIAGE HILLS DR
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City | AUGUSTA
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State | GA
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Zip | 30907-8208
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Country | US
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Telephone | 912-980-7342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 183500000X
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License Number State | GA
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