Provider Demographics
NPI:1346712064
Name:NOLES, LISA L (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:NOLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 IRA L SMITH RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-8733
Mailing Address - Country:US
Mailing Address - Phone:850-843-0030
Mailing Address - Fax:
Practice Address - Street 1:4727 IRA L SMITH RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-8733
Practice Address - Country:US
Practice Address - Phone:850-843-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily