Provider Demographics
NPI:1851456347
Name:SARTORI, LISA M (PAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SARTORI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:ALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-369-0286
Mailing Address - Fax:352-867-5076
Practice Address - Street 1:700 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7314
Practice Address - Country:US
Practice Address - Phone:352-787-9838
Practice Address - Fax:352-787-8705
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102411363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLP00702088OtherRR MEDICARE
FLY04KNOtherBCBS OF FLORIDA
FLU2339OtherBCBSFL
FLY04KNOtherBCBS OF FLORIDA
FLU2339XMedicare PIN
FLU2339VMedicare PIN
FLU2339SMedicare PIN
FLU2339WMedicare PIN
FLU2339TMedicare PIN
FLU2339OtherBCBSFL
FLU2339RMedicare PIN