Provider Demographics
NPI:1518334424
Name:HOBBS, LISA BULLOCK (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BULLOCK
Last Name:HOBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNETTE
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:109 TURKEY POINT CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8146
Mailing Address - Country:US
Mailing Address - Phone:803-465-1768
Mailing Address - Fax:
Practice Address - Street 1:109 TURKEY POINT CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8146
Practice Address - Country:US
Practice Address - Phone:803-465-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse