MEDICARE: LISA M FERRIS 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	163W00000X	Registered Nurse	167687	TN
2	363LF0000X	Family Nurse Practitioner	9299783	FL

General Provider Information

NPI Number	:	1558593368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M FERRIS ARNP

Provider Business Mailing Address
First Line	:	4703 W PAUL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3325
Country	:	US
Telephone Number	:	615-400-7776
Fax Number	:

Provider Business Practice Location Address
First Line	:	4703 W PAUL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3325
Country	:	US
Telephone Number	:	615-400-7776
Fax Number	:

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

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	10/09/2012

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