Provider Demographics
NPI:1659855435
Name:GODWIN, LISA J (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:GODWIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 PARKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2154
Mailing Address - Country:US
Mailing Address - Phone:865-548-5240
Mailing Address - Fax:
Practice Address - Street 1:1419 PARKRIDGE CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2154
Practice Address - Country:US
Practice Address - Phone:865-548-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24714208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist