Provider Demographics
NPI:1891966040
Name:BRUTON, LILLIE SHANELL (ARNP)
Entity type:Individual
Prefix:
First Name:LILLIE
Middle Name:SHANELL
Last Name:BRUTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LILLIE
Other - Middle Name:SHANELL
Other - Last Name:TOOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:3554 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8402
Practice Address - Country:US
Practice Address - Phone:727-321-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2801422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily