Healthcare Provider Details

I. General information

NPI: 1861861973
Provider Name (Legal Business Name): LISA HOLCOMB ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441 STE 930
THE VILLAGES FL
32159-6812
US

IV. Provider business mailing address

1400 N US HIGHWAY 441 STE 930
THE VILLAGES FL
32159-6812
US

V. Phone/Fax

Practice location:
  • Phone: 863-291-5110
  • Fax: 863-291-5128
Mailing address:
  • Phone: 863-291-5110
  • Fax: 863-291-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9298814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: