Provider Demographics
NPI:1043443468
Name:LAVOIE, LISA A (PA-C, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:PA-C, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6314
Mailing Address - Country:US
Mailing Address - Phone:407-244-8559
Mailing Address - Fax:407-244-8560
Practice Address - Street 1:1200 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6314
Practice Address - Country:US
Practice Address - Phone:407-244-8559
Practice Address - Fax:407-244-8560
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101423363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM766ZMedicare UPIN