Healthcare Provider Details

I. General information

NPI: 1831133446
Provider Name (Legal Business Name): LISA A WHIMS-SQUIRES D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 SOUTH FT. HARRISON AVE. BLDG. G
CLEARWATER FL
33756
US

IV. Provider business mailing address

2840 W BAY DR SUITE 273
BELLEAIR BLUFFS FL
33770-2620
US

V. Phone/Fax

Practice location:
  • Phone: 727-466-9847
  • Fax: 727-466-0346
Mailing address:
  • Phone: 727-466-9847
  • Fax: 727-466-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0S6918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: