Provider Demographics
NPI:1356109789
Name:LILLARD, DARNESHA J (LPN)
Entity type:Individual
Prefix:
First Name:DARNESHA
Middle Name:J
Last Name:LILLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 OLD KINGS RD S APT 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4140
Mailing Address - Country:US
Mailing Address - Phone:904-866-9396
Mailing Address - Fax:
Practice Address - Street 1:8030 OLD KINGS RD S APT 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4140
Practice Address - Country:US
Practice Address - Phone:904-866-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5236284164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse