Provider Demographics
NPI:1528492196
Name:MERIDETH, LILLIAN THERESA (CNA)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:THERESA
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WILD PINE RD
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-6211
Mailing Address - Country:US
Mailing Address - Phone:407-242-8048
Mailing Address - Fax:
Practice Address - Street 1:931 WILD PINE RD
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-6211
Practice Address - Country:US
Practice Address - Phone:407-242-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 192499376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide