MEDICARE: MS. JENNIFER L LISKA CONNER 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	363LG0600X	Gerontology Nurse Practitioner	11002903	FL
2	163WG0600X	Gerontology Registered Nurse	2279	WI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336284660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER L LISKA CONNER APRN

Provider Business Mailing Address
First Line	:	1507 S HIAWASSEE RD STE 107
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5706
Country	:	US
Telephone Number	:	407-445-9545
Fax Number	:	407-299-6160

Provider Business Practice Location Address
First Line	:	1507 S HIAWASSEE RD STE 107
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5706
Country	:	US
Telephone Number	:	407-445-9545
Fax Number	:	407-445-9545

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/18/2019

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