Provider Demographics
NPI:1336284660
Name:LISKA CONNER, JENNIFER L (APRN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:LISKA CONNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LISKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-445-9545
Mailing Address - Fax:407-299-6160
Practice Address - Street 1:1507 S HIAWASSEE RD STE 107
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-445-9545
Practice Address - Fax:407-445-9545
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002903363LG0600X
WI2279163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41252100Medicaid
WIQ36662Medicare UPIN