Healthcare Provider Details

I. General information

NPI: 1700595410
Provider Name (Legal Business Name): LISA HERSHISER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA CRISCUOLO

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 COLLEGE POINTE CT
FORT MYERS FL
33919-3245
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9100
  • Fax:
Mailing address:
  • Phone: 239-343-9100
  • Fax: 239-343-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11020342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11020342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: