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General NPI Number Information
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NPI Number | 1528581840
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Entity Type | Individual
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Provider Name | LISA MARRA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 3441 SE WILLOUGHBY BLVD
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City | STUART
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State | FL
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Zip | 34994-5060
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Country | US
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Telephone | 772-221-4000
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Fax | 772-221-4041
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Provider Business Mailing Address
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Address Line | 2839 E STATE ROAD 80
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City | LABELLE
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State | FL
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Zip | 33935-4786
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Country | US
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Telephone | 239-898-0622
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN9210862
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9210862
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License Number State | FL
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