Provider Demographics
NPI:1548570005
Name:KANAKRY, LISA A (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:KANAKRY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:MIQUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:15802 92ND WAY N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6937
Mailing Address - Country:US
Mailing Address - Phone:561-512-0049
Mailing Address - Fax:
Practice Address - Street 1:5154 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4501
Practice Address - Country:US
Practice Address - Phone:561-683-1400
Practice Address - Fax:561-683-6773
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2200402163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice