Provider Demographics
NPI:1497063242
Name:FREEMAN, LISA MARIE DORTO (CAA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE DORTO
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DORTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:7700 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4113
Mailing Address - Country:US
Mailing Address - Phone:720-462-5373
Mailing Address - Fax:
Practice Address - Street 1:1901 SW 172ND AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-538-4600
Practice Address - Fax:954-538-4615
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA63367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant