Healthcare Provider Details

I. General information

NPI: 1629711536
Provider Name (Legal Business Name): LISA HITCHCOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

214 OVIEDO ST
GULF BREEZE FL
32561-4030
US

V. Phone/Fax

Practice location:
  • Phone: 850-375-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN9239905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: