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General NPI Number Information
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NPI Number | 1194244228
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Entity Type | Individual
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Provider Name | LISA A STANFORD FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 10301 HAGEN RANCH RD STE D720
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3777
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Country | US
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Telephone | 561-264-0802
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 LARCH WAY
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City | WELLINGTON
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State | FL
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Zip | 33414-5101
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Country | US
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Telephone | 561-319-5040
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9179520
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License Number State | FL
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