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General NPI Number Information
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NPI Number | 1003055955
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Entity Type | Individual
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Provider Name | LISSA WEST FNP
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Gender | Female
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 3606 MACLAY BLVD STE 102
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City | TALLAHASSEE
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State | FL
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Zip | 32312
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Country | US
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Telephone | 805-877-1162
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Fax | 850-671-5009
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Provider Business Mailing Address
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Address Line | 3606 MACLAY BLVD STE 102
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City | TALLAHASSEE
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State | FL
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Zip | 32312
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Country | US
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Telephone | 805-877-1162
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Fax | 850-671-5009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 115113 R.N.
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 7609 A.P.N.
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 07609
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License Number State | TN
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