Provider Demographics
NPI:1619216694
Name:GARRETT, LISA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1169 HOKUA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5803
Mailing Address - Country:US
Mailing Address - Phone:808-389-2074
Mailing Address - Fax:
Practice Address - Street 1:599 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-674-9500
Practice Address - Fax:808-674-9436
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily