Provider Demographics
NPI:1497919443
Name:AENLLE, LISA MARIE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:AENLLE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:AENLLE-MATUSZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:1660 MEDICAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1416
Practice Address - Country:US
Practice Address - Phone:239-566-3434
Practice Address - Fax:877-812-5411
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1167542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP012358113OtherMEDICARE RAILROAD
FL14S7GOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL3751549OtherUNITED HEALTH CARE PPO
FL3751549OtherUNITED HEALTH CARE PPO
FL009979100Medicaid
FL40935Medicare PIN
FL40935BMedicare PIN