Healthcare Provider Details

I. General information

NPI: 1053506873
Provider Name (Legal Business Name): LISA ANN REX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 DAVID WALKER DR
EUSTIS FL
32726-6177
US

IV. Provider business mailing address

5000 CHESHIRE LN N
PLYMOUTH MN
55446-3706
US

V. Phone/Fax

Practice location:
  • Phone: 352-589-4327
  • Fax: 352-589-0959
Mailing address:
  • Phone: 888-333-9152
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: