Provider Demographics
NPI:1225398852
Name:MARSHALL, LISA BETHANY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETHANY
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1314 E LAS OLAS BLVD STE 1545
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-973-5533
Mailing Address - Fax:954-337-3721
Practice Address - Street 1:648 NW 183RD STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:954-973-5533
Practice Address - Fax:954-337-3721
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant