=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245560150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA M WILLIAMS CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2009
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4901 GRANDE DR
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-477-7042
-----------------------------------------------------
Fax | 850-474-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7608 HARVEST LN
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49002-9454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-491-3263
-----------------------------------------------------
Fax | 269-327-1560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | ARNP9301737
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------