Provider Demographics
NPI:1376228312
Name:LIBERTY MOBILE MEDICAL LLC
Entity Type:Organization
Organization Name:LIBERTY MOBILE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP, ACHPN
Authorized Official - Phone:727-366-2144
Mailing Address - Street 1:15366 EASTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8184
Mailing Address - Country:US
Mailing Address - Phone:727-366-2144
Mailing Address - Fax:
Practice Address - Street 1:15366 EASTWOOD TRL
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34604-8184
Practice Address - Country:US
Practice Address - Phone:727-366-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty