Provider Demographics
NPI:1861184533
Name:MANN, LILLIAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 NORTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8933
Mailing Address - Country:US
Mailing Address - Phone:800-827-7546
Mailing Address - Fax:863-421-0466
Practice Address - Street 1:2205 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8933
Practice Address - Country:US
Practice Address - Phone:800-827-7546
Practice Address - Fax:863-421-0466
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9117659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant