Provider Demographics
NPI:1982658662
Name:MAZEIKA, LISA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MAZEIKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WILLIAM HILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2497
Mailing Address - Country:US
Mailing Address - Phone:843-738-4800
Mailing Address - Fax:843-738-4801
Practice Address - Street 1:460 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2497
Practice Address - Country:US
Practice Address - Phone:843-738-4800
Practice Address - Fax:843-738-4801
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001688L363A00000X
SCBLC1791174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06035Medicare UPIN