Provider Demographics
NPI:1336327725
Name:PANNELL, LISA M (NNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:PANNELL
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 GOTWALT DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6966
Mailing Address - Country:US
Mailing Address - Phone:407-256-3009
Mailing Address - Fax:
Practice Address - Street 1:2718 N ORANGE AVE STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7611
Practice Address - Country:US
Practice Address - Phone:407-894-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13068363LN0005X
FL9166765363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care