Provider Demographics
NPI:1508963042
Name:BERNARD, LISA ANN (MS ARNP CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MS ARNP CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 BEE RIDGE ROAD
Mailing Address - Street 2:BUILDING A SUITE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-923-3667
Mailing Address - Fax:941-924-3246
Practice Address - Street 1:3920 BEE RIDGE ROAD
Practice Address - Street 2:BUILDING A SUITE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-923-3667
Practice Address - Fax:941-924-3246
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179876163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306394100Medicaid