Provider Demographics
NPI:1679731608
Name:SMITH, LILLIAN T (CFA, BAH)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFA, BAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-391-5186
Mailing Address - Fax:352-751-8818
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-391-5186
Practice Address - Fax:352-751-8818
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF00763246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant