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General NPI Number Information
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NPI Number | 1598644718
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Entity Type | Organization
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Legal Business Name | LIAMIA LLC
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 9220 BONITA BEACH RD SE STE 221
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4235
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Country | US
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Telephone | 507-358-3085
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Fax | 813-696-3705
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Provider Business Mailing Address
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Address Line | 9220 BONITA BEACH RD SE STE 221
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4235
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Country | US
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Telephone | 507-358-3085
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Fax | 813-696-3705
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Authorized Official
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Title or Position | CCO
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Name | MARIA DORAN-THREAT
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Credential | NP
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Telephone | 507-358-3085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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