Provider Demographics
NPI:1609834571
Name:TUSSET, LISA ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:TUSSET
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10354 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5813
Mailing Address - Country:US
Mailing Address - Phone:734-354-3100
Mailing Address - Fax:
Practice Address - Street 1:2999 S TAMIAMI TRL
Practice Address - Street 2:SUNCOAST ENDOSCOPY A PROPOS ANESTHESIA
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5106
Practice Address - Country:US
Practice Address - Phone:941-362-7847
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224162367500000X
MI4704136651367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1804607Medicaid
MI1804607Medicaid
MIN47230059Medicare ID - Type Unspecified
MIOF36438025Medicare ID - Type Unspecified