Healthcare Provider Details

I. General information

NPI: 1861987604
Provider Name (Legal Business Name): LISA M TRAUTMAN APRN PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 GARRISON AVE
PORT ST JOE FL
32456-5265
US

IV. Provider business mailing address

2475 GARRISON AVE
PORT ST JOE FL
32456-5265
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-9220
  • Fax:
Mailing address:
  • Phone: 850-227-9220
  • Fax: 850-807-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11033104
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: