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NPI Code Detail

MEDICARE: LISE MICHELLE MCCANLESS APRN

MEDICARE: LISE MICHELLE MCCANLESS 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
1363LF0000XFamily Nurse Practitioner9876VI
2363L00000XNurse Practitioner0024118550VA
3363LF0000XFamily Nurse PractitionerARNP9436627FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710185079
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISE MICHELLE MCCANLESS APRN
Provider Business Mailing Address
First Line : 380 TERN DR APT 3
Second Line :
City : NAPLES
State : FL
Zip : 34112-3922
Country : US
Telephone Number : 757-457-5100
Fax Number : 757-819-7762
Provider Business Practice Location Address
First Line : 8831 IMMOKALEE RD
Second Line :
City : NAPLES
State : FL
Zip : 34120-3914
Country : US
Telephone Number : 757-457-5100
Fax Number : 757-819-7762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 07/01/2016

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