Healthcare Provider Details

I. General information

NPI: 1619290673
Provider Name (Legal Business Name): LISA MARIE NEUENFELDT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

IV. Provider business mailing address

2422 BREEZY LN
PANAMA CITY FL
32405-3917
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0036
  • Fax: 850-763-0259
Mailing address:
  • Phone: 850-258-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberARNP9185753
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9185753
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9185753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: