Healthcare Provider Details

I. General information

NPI: 1740015536
Provider Name (Legal Business Name): LISA ESPOSITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 W SWANN AVE
TAMPA FL
33609-4086
US

IV. Provider business mailing address

1156 MULTIFLORA LOOP
LUTZ FL
33558-2325
US

V. Phone/Fax

Practice location:
  • Phone: 813-878-0089
  • Fax:
Mailing address:
  • Phone: 813-867-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: