Healthcare Provider Details

I. General information

NPI: 1821430521
Provider Name (Legal Business Name): LISA RAMOS ARCHBOLD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HEALTH CARE DR STE B
TRINITY FL
34655-5377
US

IV. Provider business mailing address

1815 HEALTH CARE DR STE B
TRINITY FL
34655-5377
US

V. Phone/Fax

Practice location:
  • Phone: 727-524-4464
  • Fax: 727-210-6945
Mailing address:
  • Phone: 727-524-4464
  • Fax: 727-210-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP 2194342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: