Provider Demographics
NPI:1548598782
Name:BECKER, LISA FORMAN (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FORMAN
Last Name:BECKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2009
Mailing Address - Country:US
Mailing Address - Phone:954-763-2030
Mailing Address - Fax:954-763-9847
Practice Address - Street 1:919 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2009
Practice Address - Country:US
Practice Address - Phone:954-763-2030
Practice Address - Fax:954-763-9847
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9191528364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health