Provider Demographics
NPI:1558504563
Name:PEDONE, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:PEDONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 STATLER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-3359
Mailing Address - Country:US
Mailing Address - Phone:352-398-5787
Mailing Address - Fax:352-686-8219
Practice Address - Street 1:2495 STATLER AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-3359
Practice Address - Country:US
Practice Address - Phone:352-398-5787
Practice Address - Fax:352-686-8219
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5156411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse