Healthcare Provider Details

I. General information

NPI: 1528581840
Provider Name (Legal Business Name): LISA MARRA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH BRADY HAUKE MARRA

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 SE WILLOUGHBY BLVD
STUART FL
34994-5060
US

IV. Provider business mailing address

2839 E STATE ROAD 80
LABELLE FL
33935-4786
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-4000
  • Fax: 772-221-4041
Mailing address:
  • Phone: 239-898-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN9210862
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9210862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: