=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306210505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA PHILLIPS ARNP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2015
-----------------------------------------------------
Last Update Date | 03/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2510 HIGH OAKS LN
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-523-1718
-----------------------------------------------------
Fax | 813-433-5518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 857
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33548-0857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-523-1718
-----------------------------------------------------
Fax | 813-433-5518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | LISA R PHILLIPS
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 813-523-1718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9230170
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------