Provider Demographics
NPI:1598644718
Name:LIAMIA LLC
Entity type:Organization
Organization Name:LIAMIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAN-THREAT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:507-358-3085
Mailing Address - Street 1:9220 BONITA BEACH RD SE STE 221
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4235
Mailing Address - Country:US
Mailing Address - Phone:507-358-3085
Mailing Address - Fax:813-696-3705
Practice Address - Street 1:9220 BONITA BEACH RD SE STE 221
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4235
Practice Address - Country:US
Practice Address - Phone:507-358-3085
Practice Address - Fax:813-696-3705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIAMIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-01
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty