Provider Demographics
NPI:1477704039
Name:CRANDALL, LISA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14700 TAYLOR VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8260
Mailing Address - Country:US
Mailing Address - Phone:678-580-0815
Mailing Address - Fax:678-903-0175
Practice Address - Street 1:5245 BUFORD HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-2654
Practice Address - Country:US
Practice Address - Phone:678-903-0148
Practice Address - Fax:678-903-0175
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily