Healthcare Provider Details

I. General information

NPI: 1700122264
Provider Name (Legal Business Name): LISA RENEE CRONIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8500
  • Fax:
Mailing address:
  • Phone: 813-974-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number254516
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123298
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME123298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: