MEDICARE: MS. LISA A BRAUN ARNP, JD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP 2564812	FL

General Provider Information

NPI Number	:	1124000542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA A BRAUN ARNP, JD

Provider Business Mailing Address
First Line	:	1084 POCAHONTAS ST
Second Line	:	REGIONAL SUPPORT ORGANIZATION
City	:	NORFOLK
State	:	VA
Zip	:	23511-2133
Country	:	US
Telephone Number	:	757-445-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1084 POCAHONTAS ST
Second Line	:	REGIONAL SUPPORT ORGANIZATION
City	:	NORFOLK
State	:	VA
Zip	:	23511-2133
Country	:	US
Telephone Number	:	757-445-9040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	09/04/2007

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