Provider Demographics
NPI:1053303230
Name:ROBERTSON, LILLIAN T (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:T
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1511
Mailing Address - Country:US
Mailing Address - Phone:931-403-5939
Mailing Address - Fax:931-403-5939
Practice Address - Street 1:403 E UNIVERSITY STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:35870-0001
Practice Address - Country:US
Practice Address - Phone:931-403-5939
Practice Address - Fax:931-403-5940
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3345734Medicaid
TN3345734Medicare ID - Type Unspecified
S55604Medicare UPIN