Provider Demographics
NPI:1528020476
Name:PARSONS, LISA A (DPM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:PARSONS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 ICOT BLVD
Mailing Address - Street 2:BLD B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3703
Mailing Address - Country:US
Mailing Address - Phone:727-796-6900
Mailing Address - Fax:
Practice Address - Street 1:13600 ICOT BLVD
Practice Address - Street 2:BLD B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3703
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM457213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3022977OtherBCBST
TN3352380Medicaid
TN480028979Medicare PIN
TN3022977OtherBCBST
TN4254310001Medicare NSC
TN3352380Medicare PIN