Provider Demographics
NPI:1700421450
Name:SMITH-HANNON, LISA MARIE (APRN-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SMITH-HANNON
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5325 LENA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9442
Mailing Address - Country:US
Mailing Address - Phone:941-301-8485
Mailing Address - Fax:941-799-6841
Practice Address - Street 1:5325 LENA RD STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9442
Practice Address - Country:US
Practice Address - Phone:941-301-8485
Practice Address - Fax:941-799-6841
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005075363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology