Provider Demographics
NPI:1457103046
Name:ANDERSON, KILIA L (MT)
Entity type:Individual
Prefix:MRS
First Name:KILIA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:KILIA
Other - Middle Name:
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 E JACKSON ST STE 2340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5226
Mailing Address - Country:US
Mailing Address - Phone:813-934-2268
Mailing Address - Fax:813-934-2278
Practice Address - Street 1:401 E JACKSON ST STE 2340
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5226
Practice Address - Country:US
Practice Address - Phone:813-934-2268
Practice Address - Fax:813-934-2278
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory