Provider Demographics
NPI:1255328225
Name:REISNER, LISA CAROL (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:REISNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CAROL
Other - Last Name:ROTHENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:7324 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5518
Mailing Address - Country:US
Mailing Address - Phone:727-484-7722
Mailing Address - Fax:727-484-7781
Practice Address - Street 1:433 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0209
Practice Address - Country:US
Practice Address - Phone:352-732-4032
Practice Address - Fax:352-732-4191
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 0935622363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015120300Medicaid
FL015120300Medicaid
FLU2820XMedicare PIN