Provider Demographics
NPI:1083743207
Name:MAGARY, LISA CARMEN (DNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CARMEN
Last Name:MAGARY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 NW 57TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6437
Mailing Address - Country:US
Mailing Address - Phone:352-474-8686
Mailing Address - Fax:
Practice Address - Street 1:919 NW 57TH ST STE 10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6437
Practice Address - Country:US
Practice Address - Phone:352-474-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9234311363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308334900Medicaid
AD618ZMedicare PIN
FLAD618XMedicare PIN