Provider Demographics
NPI:1073569802
Name:MEYERS, LISA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117
Mailing Address - Country:US
Mailing Address - Phone:239-777-9243
Mailing Address - Fax:239-352-0737
Practice Address - Street 1:1005 CROSSPOINTE DR STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0947
Practice Address - Country:US
Practice Address - Phone:239-566-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLARNP9221237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306610000Medicaid
FL306610000Medicaid