Healthcare Provider Details

I. General information

NPI: 1245560150
Provider Name (Legal Business Name): LISA M WILLIAMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

IV. Provider business mailing address

7608 HARVEST LN
PORTAGE MI
49002-9454
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-7042
  • Fax: 850-474-9060
Mailing address:
  • Phone: 269-491-3263
  • Fax: 269-327-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9301737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: