Provider Demographics
NPI:1679692453
Name:COHEN, LISA REBECCA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:REBECCA
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:REBECCA
Other - Last Name:MANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 OCEAN DR STE 8
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5131
Mailing Address - Country:US
Mailing Address - Phone:561-737-4777
Mailing Address - Fax:
Practice Address - Street 1:2015 OCEAN DR STE 8
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5131
Practice Address - Country:US
Practice Address - Phone:561-737-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103886363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical