Healthcare Provider Details

I. General information

NPI: 1750348058
Provider Name (Legal Business Name): LISA M COHEN D. O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 TAMPA ROAD SUITE 304
PALM HARBOR FL
34684
US

IV. Provider business mailing address

3890 TAMPA ROAD SUITE 304
PALM HARBOR FL
34684
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-9006
  • Fax: 727-789-9122
Mailing address:
  • Phone: 727-789-9006
  • Fax: 727-789-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: