MEDICARE: LISA O'NEILL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1689475451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA O'NEILL, LLC

Provider Business Mailing Address
First Line	:	327 S COUNTY HIGHWAY 393 UNIT 201D
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-8209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 S COUNTY HIGHWAY 393 UNIT 201D
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-8209
Country	:	US
Telephone Number	:	850-990-0636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA E O'NEILL
Credential	:	APRN
Telephone Number	:	850-990-0636

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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