Provider Demographics
NPI:1821300062
Name:DEWITT, LISA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 RACE TRACK RD
Mailing Address - Street 2:SUITE NUMBER 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3102
Mailing Address - Country:US
Mailing Address - Phone:800-659-1522
Mailing Address - Fax:800-776-7713
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:SUITE NUMBER 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3102
Practice Address - Country:US
Practice Address - Phone:800-659-1522
Practice Address - Fax:800-776-7713
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189269 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health