Healthcare Provider Details

I. General information

NPI: 1417535881
Provider Name (Legal Business Name): LISA MARIE ROSS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W HILLSBORO BLVD STE 101
DEERFIELD BEACH FL
33442-1423
US

IV. Provider business mailing address

PO BOX 4189
DEERFIELD BEACH FL
33442-4189
US

V. Phone/Fax

Practice location:
  • Phone: 954-908-4962
  • Fax: 954-908-4963
Mailing address:
  • Phone: 954-363-9582
  • Fax: 954-363-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: