Healthcare Provider Details

I. General information

NPI: 1639680721
Provider Name (Legal Business Name): LISA MARIE STILES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-9215
US

IV. Provider business mailing address

12780 WATERFORD LAKES PKWY STE 120
ORLANDO FL
32828-4501
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax:
Mailing address:
  • Phone: 321-841-9514
  • Fax: 407-636-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9291927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: