Provider Demographics
NPI:1982670303
Name:GITTLEMAN, LISA MELONY (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MELONY
Last Name:GITTLEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 S ABINGDON ST APT B2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1361
Mailing Address - Country:US
Mailing Address - Phone:858-229-2473
Mailing Address - Fax:
Practice Address - Street 1:2120 WASHINGTON BLVD
Practice Address - Street 2:SEQUOIA 3/3RD FLOOR
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily