MEDICARE: LISA MARIE FERGUSON CRNA

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	ARNP9167524	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G4065	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861425548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE FERGUSON CRNA

Provider Business Mailing Address
First Line	:	7101 FAIRWAY DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3701
Country	:	US
Telephone Number	:	561-515-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 FAIRWAY DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3701
Country	:	US
Telephone Number	:	561-515-1500
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/29/2018

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