Provider Demographics
NPI:1649203126
Name:DELLA RATTA, LISA MARIE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DELLA RATTA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:KOCON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-4040
Mailing Address - Fax:
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-4040
Practice Address - Fax:850-416-4039
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9180138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherTRICARE PROVIDERNUMBER
FLPENDINGMedicare ID - Type UnspecifiedPROVIDER NNUMBER