Provider Demographics
NPI:1275583122
Name:SMITH, LISA J (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:562 PARK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2918
Mailing Address - Country:US
Mailing Address - Phone:904-633-2021
Mailing Address - Fax:904-633-9793
Practice Address - Street 1:1801 BARRS ST
Practice Address - Street 2:SUITE 500
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4732
Practice Address - Country:US
Practice Address - Phone:904-388-1820
Practice Address - Fax:904-388-1827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9201686363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health