Provider Demographics
NPI:1306348222
Name:HUMMER, LILLIAN E (RN, BSN, PAC, CNM)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:E
Last Name:HUMMER
Suffix:
Gender:F
Credentials:RN, BSN, PAC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26029
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-6029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3239
Practice Address - Country:US
Practice Address - Phone:352-463-2374
Practice Address - Fax:352-463-2726
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2137392367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife