Provider Demographics
NPI:1437734035
Name:MAYARD, LISENIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISENIE
Middle Name:
Last Name:MAYARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 BERRY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5936
Mailing Address - Country:US
Mailing Address - Phone:407-690-0775
Mailing Address - Fax:
Practice Address - Street 1:1015 BERRY LEAF CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5936
Practice Address - Country:US
Practice Address - Phone:407-690-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009601363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health