Healthcare Provider Details

I. General information

NPI: 1255328225
Provider Name (Legal Business Name): LISA CAROL REISNER A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA CAROL ROTHENBERG A.R.N.P.

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SW 10TH ST
OCALA FL
34471-0209
US

IV. Provider business mailing address

7324 LITTLE RD
NEW PORT RICHEY FL
34654-5518
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-4032
  • Fax: 352-732-4191
Mailing address:
  • Phone: 727-484-7722
  • Fax: 727-484-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 0935622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: