Provider Demographics
NPI:1861846214
Name:BEAURY, LISA (DOM / AP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BEAURY
Suffix:
Gender:F
Credentials:DOM / AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2415
Mailing Address - Country:US
Mailing Address - Phone:407-682-7111
Mailing Address - Fax:407-682-7180
Practice Address - Street 1:460 W CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2415
Practice Address - Country:US
Practice Address - Phone:407-682-7111
Practice Address - Fax:407-682-7180
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist