Provider Demographics
NPI:1982664280
Name:GARNER, LISA A (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GARNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:401 CORBETT ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7302
Practice Address - Country:US
Practice Address - Phone:727-250-1115
Practice Address - Fax:727-475-9015
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME132751207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110175500Medicaid
TX098021101Medicaid
TX288128601Medicaid
TX098021101Medicaid