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Organization
LILLYS MEDICAL CENTER LLC
Active
Organization
LILLYS MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGETTE L PROVOST-DUKES ARNP (ARNP)
(407) 719-5723
Entity
Organization
Contact information
Practice address
4241 BAYMEADOWS RD STE 6, JACKSONVILLE, FL 32217-4673
(407) 719-5723
Mailing address
4241 BAYMEADOWS RD STE 6, JACKSONVILLE, FL 32217-4673
(407) 719-5723
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/04/2021
Last updated
03/17/2021
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