MEDICARE: LISA ANNE BRUNTON COOLEY APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2776972	FL
2	363LF0000X	Family Nurse Practitioner	2776972	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154359883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANNE BRUNTON COOLEY APRN

Provider Business Mailing Address
First Line	:	17929 HUNTING BOW CIR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5378
Country	:	US
Telephone Number	:	813-792-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	17929 HUNTING BOW CIR STE 101
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5378
Country	:	US
Telephone Number	:	813-792-8555
Fax Number	:	813-792-0555

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/25/2024

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