Healthcare Provider Details

I. General information

NPI: 1467246819
Provider Name (Legal Business Name): LISA CHRISTINE EADDY RRT-ACCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

6216 NW 41ST DR
GAINESVILLE FL
32653-8379
US

V. Phone/Fax

Practice location:
  • Phone: 800-324-8387
  • Fax:
Mailing address:
  • Phone: 352-812-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number15997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: