Provider Demographics
NPI:1801320452
Name:HILL, LERAE J (APRN)
Entity type:Individual
Prefix:
First Name:LERAE
Middle Name:J
Last Name:HILL
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 1:533 SW 110TH LN APT 208
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6991
Mailing Address - Country:US
Mailing Address - Phone:404-729-6233
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD STE C407
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6592
Practice Address - Country:US
Practice Address - Phone:305-981-1700
Practice Address - Fax:844-270-3323
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002167363LG0600X, 363LP0808X
GARN225861363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty