MEDICARE: MS. LISA M NESBITT C.R.N.A.

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	367500000X	Certified Registered Nurse Anesthetist	ARNP9259783	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	:	1518146018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA M NESBITT C.R.N.A.

Provider Business Mailing Address
First Line	:	216 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5135
Country	:	US
Telephone Number	:	904-824-6108
Fax Number	:	904-823-9613

Provider Business Practice Location Address
First Line	:	216 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5135
Country	:	US
Telephone Number	:	904-824-6108
Fax Number	:	904-823-9613

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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