=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922735695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ANN BISOGNA-MONSERRATE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2022
-----------------------------------------------------
Last Update Date | 08/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9970 CENTRAL PARK BLVD N STE 400
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-487-7931
-----------------------------------------------------
Fax | 561-487-1204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9970 CENTRAL PARK BLVD N STE 400
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-487-7931
-----------------------------------------------------
Fax | 561-487-1204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 11019980
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11019980
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------