Healthcare Provider Details

I. General information

NPI: 1255761227
Provider Name (Legal Business Name): LISA HERRINGTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 STARLING ST STE 603
BRUNSWICK GA
31520-4271
US

IV. Provider business mailing address

PO BOX 30131
SEA ISLAND GA
31561
US

V. Phone/Fax

Practice location:
  • Phone: 912-280-9977
  • Fax:
Mailing address:
  • Phone: 843-302-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number225241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: