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General NPI Number Information
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NPI Number | 1780197111
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Entity Type | Individual
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Provider Name | LISA MARIE PERKINS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 28149 HWY 27
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City | DUNDEE
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State | FL
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Zip | 33838-4274
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Country | US
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Telephone | 863-438-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 98 CENTER ST
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5313
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Country | US
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Telephone | 863-514-6761
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9279638
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License Number State | FL
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