Provider Demographics
NPI:1760510366
Name:SMITH, LISA N (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:N
Other - Last Name:STREFLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31313 NORTHWESTERN HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2577
Mailing Address - Country:US
Mailing Address - Phone:248-880-0123
Mailing Address - Fax:
Practice Address - Street 1:7109 NW 11TH PL
Practice Address - Street 2:ST B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3170
Practice Address - Country:US
Practice Address - Phone:352-333-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner