MEDICARE: LISA FORMAN BECKER ARNP

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	APRN9191528	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9191528	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	:	1548598782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FORMAN BECKER ARNP

Provider Business Mailing Address
First Line	:	919 NE 13TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2009
Country	:	US
Telephone Number	:	954-763-2030
Fax Number	:	954-763-9847

Provider Business Practice Location Address
First Line	:	919 NE 13TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2009
Country	:	US
Telephone Number	:	954-763-2030
Fax Number	:	954-763-9847

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

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	01/22/2019

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