Provider Demographics
NPI:1831205103
Name:ROLLAND, LILIVETTE (MD)
Entity type:Individual
Prefix:
First Name:LILIVETTE
Middle Name:
Last Name:ROLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 N ARMENIA AVE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2626
Mailing Address - Country:US
Mailing Address - Phone:813-873-1725
Mailing Address - Fax:
Practice Address - Street 1:4602 N ARMENIA AVE
Practice Address - Street 2:SUITE A 3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2626
Practice Address - Country:US
Practice Address - Phone:813-873-1725
Practice Address - Fax:813-873-2924
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59316208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH-2280188OtherFIRST CARE
FL271691700Medicaid
FL3939565OtherCIGNA
FL432062869OtherEVOLUTIONS HEALTHCARE
FL432062869OtherHUMANA
FL432062869OtherTRICARE
FL432062869OtherSOUTH CARE PPO
FL12802OtherBLUE CROSS/BLUE SHIELD
FL285461OtherWELLCARE/STAYWELL/HEALTHE
FLCCN-55OtherCCN
FL432062869OtherBAYCARE
FL432062869OtherPRIVATE HEALTH CARE
FL432062869OtherUNITED HEALTH CARE
FL278713OtherAMERIGROUP
FL3966308OtherAETNA
FL432062869OtherBEECH STREET CORP