Provider Demographics
NPI:1265491898
Name:CUNNINGHAM, LISA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6314
Mailing Address - Country:US
Mailing Address - Phone:407-244-8559
Mailing Address - Fax:407-218-4563
Practice Address - Street 1:1200 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6314
Practice Address - Country:US
Practice Address - Phone:407-244-8559
Practice Address - Fax:407-218-4563
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3198042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD266ZMedicare PIN