Healthcare Provider Details

I. General information

NPI: 1295305043
Provider Name (Legal Business Name): LISA VAUGHAN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14834 SWEET ACACIA DR
ORLANDO FL
32828-7336
US

IV. Provider business mailing address

14834 SWEET ACACIA DR
ORLANDO FL
32828-7336
US

V. Phone/Fax

Practice location:
  • Phone: 321-439-4453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT12086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: