Healthcare Provider Details

I. General information

NPI: 1063705366
Provider Name (Legal Business Name): LISA R JAMIL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 E BRANDON BLVD
BRANDON FL
33511-5509
US

IV. Provider business mailing address

10051 5TH ST N STE 200
ST PETERSBURG FL
33702-2211
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-9900
  • Fax: 813-653-9696
Mailing address:
  • Phone: 727-824-0780
  • Fax: 727-568-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9172164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: