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General NPI Number Information
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NPI Number | 1124260930
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Entity Type | Individual
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Provider Name | LISA N MCELLIGOTT PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1301 PALM AVE STE 700
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8457
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Country | US
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Telephone | 904-202-7300
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Fax | 904-202-2754
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Provider Business Mailing Address
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Address Line | PO BOX 746654
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City | ATLANTA
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State | GA
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Zip | 30374-6654
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002222
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115887
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License Number State | FL
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