Provider Demographics
NPI:1649557091
Name:BRAREN, LISA (AP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BRAREN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PLAYERS CLUB VILLAS RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3103
Mailing Address - Country:US
Mailing Address - Phone:904-772-5719
Mailing Address - Fax:
Practice Address - Street 1:62 PLAYERS CLUB VILLAS RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3103
Practice Address - Country:US
Practice Address - Phone:904-772-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist