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NPI Code Detail

MEDICARE: MRS. LISA ANNE BLACK ARNP

MEDICARE: MRS. LISA ANNE BLACK 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
1363LF0000XFamily Nurse PractitionerARNP 2159422FL

General Provider Information

NPI Number : 1780944520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA ANNE BLACK ARNP
Provider Business Mailing Address
First Line : PO BOX 561600
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32956-1600
Country : US
Telephone Number : 321-259-0635
Fax Number : 321-434-4642
Provider Business Practice Location Address
First Line : 220 S COURTENAY PKWY
Second Line : SUITE B
City : MERRITT ISLAND
State : FL
Zip : 32952-4893
Country : US
Telephone Number : 321-868-5815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2012
Last Update Date : 12/03/2012

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Directions to “ MRS. LISA ANNE BLACK ARNP” Practice Location

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