Provider Demographics
NPI:1871017350
Name:PRIESTER, LISA PICOLA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PICOLA
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 HARTLEY RD APT 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6710
Mailing Address - Country:US
Mailing Address - Phone:904-762-6428
Mailing Address - Fax:
Practice Address - Street 1:3200 HARTLEY RD APT 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6710
Practice Address - Country:US
Practice Address - Phone:904-762-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker