Provider Demographics
NPI:1528736360
Name:MEKOUDJOU TCHAKONTE, LILYNE MICHELE (NURSE PRACTITONER)
Entity type:Individual
Prefix:
First Name:LILYNE MICHELE
Middle Name:
Last Name:MEKOUDJOU TCHAKONTE
Suffix:
Gender:F
Credentials:NURSE PRACTITONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1454
Mailing Address - Country:US
Mailing Address - Phone:404-740-0112
Mailing Address - Fax:
Practice Address - Street 1:10899 SW 4TH ST APT 601
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4402
Practice Address - Country:US
Practice Address - Phone:404-740-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily