Healthcare Provider Details

I. General information

NPI: 1124000542
Provider Name (Legal Business Name): LISA A BRAUN ARNP, JD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 POCAHONTAS ST REGIONAL SUPPORT ORGANIZATION
NORFOLK VA
23511-2133
US

IV. Provider business mailing address

1084 POCAHONTAS ST REGIONAL SUPPORT ORGANIZATION
NORFOLK VA
23511-2133
US

V. Phone/Fax

Practice location:
  • Phone: 757-445-9040
  • Fax:
Mailing address:
  • Phone: 757-445-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 2564812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: