Provider Demographics
NPI:1417654518
Name:MACIAS, LILIANNE (APRN)
Entity Type:Individual
Prefix:
First Name:LILIANNE
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-3145
Mailing Address - Country:US
Mailing Address - Phone:727-836-0043
Mailing Address - Fax:
Practice Address - Street 1:1355 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-3145
Practice Address - Country:US
Practice Address - Phone:727-836-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024518363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care