Provider Demographics
NPI:1144250077
Name:FOTIADIS, LILLY ESTHER (FNP)
Entity type:Individual
Prefix:MRS
First Name:LILLY
Middle Name:ESTHER
Last Name:FOTIADIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9826 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-3527
Mailing Address - Country:US
Mailing Address - Phone:423-847-6451
Mailing Address - Fax:
Practice Address - Street 1:9826 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-3517
Practice Address - Country:US
Practice Address - Phone:423-847-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9237126363LF0000X
TN11234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308421300Medicaid
FLF0705179OtherAANP CERTIFICATION
FL308421300Medicaid