# LILLIAN INGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578146171
- **Authorized official:** LILLIAN E INGRAM NP (OWNER/OPERATOR)
- **Authorized official phone:** (608) 217-6108

## Contact information

- **Practice address:** 1211 TECH BLVD STE 105, TAMPA, FL 33619-7846
- **Practice address phone:** (813) 999-1516
- **Practice address fax:** (813) 336-8384
- **Mailing address:** 1211 TECH BLVD STE 105, TAMPA, FL 33619-7846
- **Mailing address phone:** (813) 999-1516
- **Mailing address fax:** (813) 336-8384

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/30/2021
- **Last updated:** 02/16/2022