Provider Demographics
NPI:1710557657
Name:CONROY, LISA ANN (BSN,RN,IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CONROY
Suffix:
Gender:F
Credentials:BSN,RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17473 ASHCOMB WAY
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6517
Mailing Address - Country:US
Mailing Address - Phone:813-291-4695
Mailing Address - Fax:
Practice Address - Street 1:6885 WOODY VINE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5507
Practice Address - Country:US
Practice Address - Phone:404-539-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN068462163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty