MEDICARE: MS. LISA PATRICE MCLOUGHLIN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71002026A	IN
2	363LF0000X	Family Nurse Practitioner	ARNP9270099	FL

General Provider Information

NPI Number	:	1164400941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA PATRICE MCLOUGHLIN ARNP

Provider Business Mailing Address
First Line	:	2812 WOODMERE DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4384
Country	:	US
Telephone Number	:	401-575-9848
Fax Number	:

Provider Business Practice Location Address
First Line	:	2812 WOODMERE DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4384
Country	:	US
Telephone Number	:	401-575-9848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/07/2010

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