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General NPI Number Information
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NPI Number | 1275307993
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Entity Type | Individual
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Provider Name | LISA MARCINKOSKI PA, MMS
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 6000 GLADES RD
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City | BOCA RATON
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State | FL
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Zip | 33431-7208
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Country | US
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Telephone | 561-509-5394
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Fax |
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Provider Business Mailing Address
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Address Line | 7246 NW 1ST MNR
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City | PLANTATION
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State | FL
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Zip | 33317-2267
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Country | US
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Telephone | 954-288-2919
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9102558
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License Number State | FL
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