Healthcare Provider Details

I. General information

NPI: 1306418819
Provider Name (Legal Business Name): LISA CASAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 143
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

8415 N DEXTER AVE
TAMPA FL
33604-1301
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-8319
  • Fax: 480-712-1305
Mailing address:
  • Phone: 813-458-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11014159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: