Healthcare Provider Details

I. General information

NPI: 1184548216
Provider Name (Legal Business Name): LISA L BANDY ARNP- PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3200
US

IV. Provider business mailing address

7504 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3200
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-6063
  • Fax: 863-875-6086
Mailing address:
  • Phone: 863-875-6063
  • Fax: 863-875-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11019424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: