MEDICARE: LISA E ELIASSAINT RN

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	163WI0500X	Infusion Therapy Registered Nurse	9386933	FL

General Provider Information

NPI Number	:	1285370163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA E ELIASSAINT RN

Provider Business Mailing Address
First Line	:	6125 SPRING LAKE TER
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3106
Country	:	US
Telephone Number	:	772-207-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 SPRING LAKE TER
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3106
Country	:	US
Telephone Number	:	772-361-5052
Fax Number	:

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

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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