Healthcare Provider Details

I. General information

NPI: 1396268488
Provider Name (Legal Business Name): LISA ANN STEWART FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 MONTGOMERY RD
ALTAMONTE SPRINGS FL
32714-7420
US

IV. Provider business mailing address

400 GOLF BROOK CIR APT 108
LONGWOOD FL
32779-6107
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 941-916-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9191272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: