Provider Demographics
NPI:1720012438
Name:RANKIN, LISA MELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MELAINE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:499 NW PRIMA VISTA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-344-1409
Mailing Address - Fax:772-344-9441
Practice Address - Street 1:499 NW PRIMA VISTA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-344-1409
Practice Address - Fax:772-344-9441
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0074325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253926800Medicaid
G68220Medicare UPIN
FL253926800Medicaid