MEDICARE: DR. LISA BROWN PINELLI DO

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	207Q00000X	Family Medicine Physician	19095	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	0116033214	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207Q00000X	OTHER	VA	FAMILY MEDICINE

General Provider Information

NPI Number	:	1518527506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA BROWN PINELLI DO

Provider Business Mailing Address
First Line	:	3200 CITRUS TOWER BLVD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7012
Country	:	US
Telephone Number	:	352-536-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CITRUS TOWER BLVD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7012
Country	:	US
Telephone Number	:	352-536-8200
Fax Number	:

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

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	12/17/2022

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