=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245347889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA J LEARN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 WEST OAKLAND PARK BLVD SUITE 300
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33313-1583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-380-8411
-----------------------------------------------------
Fax | 954-380-8413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3536 N FEDERAL HWY STE 100
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-6264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-380-8411
-----------------------------------------------------
Fax | 954-380-8413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 0510546L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------