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General NPI Number Information
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NPI Number | 1578146171
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Entity Type | Organization
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Legal Business Name | LILLIAN INGRAM
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1211 TECH BLVD STE 105
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City | TAMPA
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State | FL
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Zip | 33619-7846
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Country | US
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Telephone | 813-999-1516
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Fax | 813-336-8384
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Provider Business Mailing Address
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Address Line | 1211 TECH BLVD STE 105
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City | TAMPA
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State | FL
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Zip | 33619-7846
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Country | US
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Telephone | 813-999-1516
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Fax | 813-336-8384
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | LILLIAN E INGRAM
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Credential | NP
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Telephone | 608-217-6108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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