Provider Demographics
NPI:1043838451
Name:PARKER, LISA M (APRN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:13110 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3735
Mailing Address - Country:US
Mailing Address - Phone:772-581-8900
Mailing Address - Fax:772-388-9154
Practice Address - Street 1:13110 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3735
Practice Address - Country:US
Practice Address - Phone:772-581-8900
Practice Address - Fax:772-388-9154
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLF05200224207QA0505X
FL11009100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine