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General NPI Number Information
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NPI Number | 1225398852
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Entity Type | Individual
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Provider Name | LISA BETHANY MARSHALL PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 15800 PINES BLVD STE 325
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1212
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Country | US
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Telephone | 754-273-0885
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Fax | 866-610-8782
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Provider Business Mailing Address
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Address Line | 16000 PINES BLVD UNIT 822503
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City | PEMBROKE PINES
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State | FL
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Zip | 33082-9265
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Country | US
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Telephone | 754-273-0885
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Fax | 866-610-8782
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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 | PA9106430
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License Number State | FL
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