Provider Demographics
NPI:1750468153
Name:RANKIN, LISA RENEE (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MCLAURIN ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5023
Mailing Address - Country:US
Mailing Address - Phone:770-227-7416
Mailing Address - Fax:
Practice Address - Street 1:546B S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4212
Practice Address - Country:US
Practice Address - Phone:770-224-8248
Practice Address - Fax:888-285-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128950NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health