Healthcare Provider Details

I. General information

NPI: 1497919443
Provider Name (Legal Business Name): LISA MARIE AENLLE MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE AENLLE-MATUSZ MD

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 MEDICAL BLVD STE 200
NAPLES FL
34110-1416
US

IV. Provider business mailing address

3451 PINE RIDGE RD BLDG 601
NAPLES FL
34109-3922
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-3434
  • Fax: 877-812-5411
Mailing address:
  • Phone: 239-449-3072
  • Fax: 877-334-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME116754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: