MEDICARE: LISA PURCELL

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	171M00000X	Case Manager/Care Coordinator
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1427514298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PURCELL

Provider Business Mailing Address
First Line	:	2004 ERIKSON PARK CIR
Second Line	:
City	:	AUBURNDALE
State	:	FL
Zip	:	33823-5465
Country	:	US
Telephone Number	:	614-484-8408
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	863-534-0781
Fax Number	:

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

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	06/07/2024

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Directions to “ LISA PURCELL ” Practice Location

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