Healthcare Provider Details

I. General information

NPI: 1508710179
Provider Name (Legal Business Name): LISA MARIE LAPANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 EPIPHANY WAY UNIT Q-103
TRINITY FL
34655-9409
US

IV. Provider business mailing address

7421 SWEETER TIDE TRL
WESLEY CHAPEL FL
33545-5172
US

V. Phone/Fax

Practice location:
  • Phone: 727-389-4442
  • Fax:
Mailing address:
  • Phone: 781-929-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11044820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: