Provider Demographics
NPI:1114179363
Name:DEMETER, LIA A (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LIA
Middle Name:A
Last Name:DEMETER
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-748-1888
Mailing Address - Fax:561-629-5560
Practice Address - Street 1:600 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2778
Practice Address - Country:US
Practice Address - Phone:561-748-1888
Practice Address - Fax:561-629-5560
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9272984363LA2200X
MA278330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner