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General NPI Number Information
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NPI Number | 1124983994
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Entity Type | Organization
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Legal Business Name | CORNERSTONE HEALTHCARE CLINIC
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1400 DR MARTIN LUTHER KING WAY UNIT 101
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City | SARASOTA
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State | FL
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Zip | 34234-7426
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Country | US
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Telephone | 941-373-1716
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Fax | 941-373-1727
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Provider Business Mailing Address
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Address Line | 441 SALT MEADOW CIR UNIT 107
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City | BRADENTON
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State | FL
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Zip | 34208-1799
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Country | US
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Telephone | 850-693-6148
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LISA MENCHION
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Credential | APRN
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Telephone | 850-693-6148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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