Healthcare Provider Details

I. General information

NPI: 1417485129
Provider Name (Legal Business Name): LISA R COBB APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

2000 E GREENVILLE ST STE 5000
ANDERSON SC
29621-1763
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-4916
  • Fax: 864-512-4585
Mailing address:
  • Phone: 864-512-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20982
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number20982
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: