Provider Demographics
NPI:1588357677
Name:BLUE LILY PSYCHIATRY LLC
Entity type:Organization
Organization Name:BLUE LILY PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:DENAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-477-8023
Mailing Address - Street 1:4214 NW 38TH DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4473
Mailing Address - Country:US
Mailing Address - Phone:954-682-2132
Mailing Address - Fax:
Practice Address - Street 1:1451 W CYPRESS CREEK RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1953
Practice Address - Country:US
Practice Address - Phone:954-477-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty