Provider Demographics
NPI:1295006211
Name:LAURO, LISA M (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LAURO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14286 BEACH BLVD STE 19-119
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1561
Mailing Address - Country:US
Mailing Address - Phone:904-477-5258
Mailing Address - Fax:
Practice Address - Street 1:2127 E HARMONY RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3407
Practice Address - Country:US
Practice Address - Phone:970-297-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2275278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered