Healthcare Provider Details

I. General information

NPI: 1144510868
Provider Name (Legal Business Name): LISA ROSE POWNALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 TROPIC BAY CT
ORLANDO FL
32807-6390
US

IV. Provider business mailing address

PO BOX 1785
MINNEOLA FL
34755-1785
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-2121
  • Fax: 407-382-2458
Mailing address:
  • Phone: 407-927-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: