Healthcare Provider Details

I. General information

NPI: 1942591854
Provider Name (Legal Business Name): LISA A NODZON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 888-860-2778
  • Fax: 813-745-6511
Mailing address:
  • Phone: 813-745-8986
  • Fax: 813-449-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9279339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: