MEDICARE: LAURIE ANN ILIFF APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11042395	FL

General Provider Information

NPI Number	:	1720958580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE ANN ILIFF APRN

Provider Business Mailing Address
First Line	:	12574 FLAGLER CENTER BLVE STE. 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258
Country	:	US
Telephone Number	:	913-634-9598
Fax Number	:

Provider Business Practice Location Address
First Line	:	12574 FLAGLER CENTER BLVE STE. 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258
Country	:	US
Telephone Number	:	913-634-9598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	12/29/2025

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Directions to “ LAURIE ANN ILIFF APRN” Practice Location

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