Provider Demographics
NPI:1215178595
Name:VALLEE, LISA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:VALLEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HEART&SOUL
Other - Middle Name:
Other - Last Name:HOMECARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3936 S SEMORAN BLVD
Mailing Address - Street 2:#276
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4015
Mailing Address - Country:US
Mailing Address - Phone:407-601-3654
Mailing Address - Fax:407-802-2759
Practice Address - Street 1:3936 S SEMORAN BLVD
Practice Address - Street 2:#276
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4015
Practice Address - Country:US
Practice Address - Phone:407-601-3654
Practice Address - Fax:407-802-2759
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD251533717990172A00000X
FL231354372500000X, 372600000X, 3747A0650X, 376J00000X
FLPN5148922164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001720700Medicaid
FLPN5148922OtherDOH