Healthcare Provider Details

I. General information

NPI: 1548338353
Provider Name (Legal Business Name): LISA D LEMLEY GIBSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA D LEMLEY PA

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 BAYMEADOWS RD STE 9
JACKSONVILLE FL
32256-0748
US

IV. Provider business mailing address

9550 BAYMEADOWS RD STE 9
JACKSONVILLE FL
32256-0748
US

V. Phone/Fax

Practice location:
  • Phone: 904-730-5115
  • Fax: 904-828-5552
Mailing address:
  • Phone: 904-730-5115
  • Fax: 904-828-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113789
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1116
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002146RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: