Healthcare Provider Details

I. General information

NPI: 1740484997
Provider Name (Legal Business Name): LISA MARIE NEWBERRY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4098 LIBRA DR
ORLANDO FL
32816-3333
US

IV. Provider business mailing address

4098 LIBRA DR
ORLANDO FL
32816-3333
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2701
  • Fax:
Mailing address:
  • Phone: 407-823-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3234382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: