Provider Demographics
NPI:1073078044
Name:ALBADIN, LILLIE (PA)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:
Last Name:ALBADIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-876-2273
Mailing Address - Fax:
Practice Address - Street 1:801 N. ORANGE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801
Practice Address - Country:US
Practice Address - Phone:407-841-2100
Practice Address - Fax:407-841-5705
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111671363A00000X
FLPA9111671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant