Provider Demographics
NPI:1043904600
Name:EXANTUS, LIZA (RN)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:EXANTUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 50TH TER SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7630
Mailing Address - Country:US
Mailing Address - Phone:239-961-0107
Mailing Address - Fax:
Practice Address - Street 1:2800 50TH TER SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7630
Practice Address - Country:US
Practice Address - Phone:239-961-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN-2384883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse