Provider Demographics
NPI:1225811516
Name:DEESE, LISA M (CNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DEESE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 DEESE LN
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32431-7356
Mailing Address - Country:US
Mailing Address - Phone:850-693-5135
Mailing Address - Fax:
Practice Address - Street 1:2828 DEESE LN
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:FL
Practice Address - Zip Code:32431-7356
Practice Address - Country:US
Practice Address - Phone:850-693-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty