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General NPI Number Information
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NPI Number | 1184111551
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Entity Type | Individual
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Provider Name | LISA GULISH PA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 6 WOODLAND RD STE 304
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City | SAINT HELENA
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State | CA
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Zip | 94574-9562
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Country | US
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Telephone | 707-963-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 NORTHSIDE DR
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City | CLEARWATER
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State | FL
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Zip | 33761-2236
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Country | US
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Telephone | 727-499-0356
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Fax | 727-781-3312
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111231
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 57797
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License Number State | CA
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