Provider Demographics
NPI:1245390624
Name:ZIMLIN, LISA M (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ZIMLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SCHACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2086 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3714
Mailing Address - Country:US
Mailing Address - Phone:727-462-0100
Mailing Address - Fax:727-462-0177
Practice Address - Street 1:2086 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3714
Practice Address - Country:US
Practice Address - Phone:727-462-0100
Practice Address - Fax:727-462-0177
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7312ZMedicare PIN
FLU7312ZMedicare UPIN