Provider Demographics
NPI:1932282803
Name:UTSEY, LISA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:UTSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 INGRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4336
Mailing Address - Country:US
Mailing Address - Phone:863-421-6565
Mailing Address - Fax:863-421-7474
Practice Address - Street 1:900 INGRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4336
Practice Address - Country:US
Practice Address - Phone:863-421-6565
Practice Address - Fax:863-421-7474
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5831637OtherAETNA
FL172406OtherWELLCARE/STAYWELL
FL49399OtherBLUE CROSS BLUE SHIELD
FL256001101Medicaid