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Provider Information for 1073669172

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

LISA PAULETTE PANISH

Other Name:   LISA WILSON
Gender: FEMALE

Individual NPI: 1073669172

Calendar   Last Updated:  2019-08-19
  Certification Date: 

Details

Name Value
NPI 1073669172
Enumeration Date 2007-01-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 9009 CORPORATE LAKE DR
TAMPA, FL 33634-2367
United States

Phone: 727-433-0157 | Fax:
View Map External Link
Primary Practice Address 9009 CORPORATE LAKE DR
TAMPA, FL 33634-2367
United States

Phone: 727-433-0157 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LG0600X - Nurse Practitioner Gerontology FL APRN2975062