Healthcare Provider Details

I. General information

NPI: 1447246616
Provider Name (Legal Business Name): LISA B COLASURDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PARKSIDE ACORN DR
INMAN SC
29349-8344
US

IV. Provider business mailing address

1220 PARKSIDE ACORN DR
INMAN SC
29349-8344
US

V. Phone/Fax

Practice location:
  • Phone: 864-516-1783
  • Fax:
Mailing address:
  • Phone: 864-516-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 875
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: