Provider Demographics
NPI:1336580729
Name:BARRETT, LISA (DNP, APRN, BCBA)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:DNP, APRN, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13298 LONG CYPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5573
Mailing Address - Country:US
Mailing Address - Phone:904-994-0747
Mailing Address - Fax:
Practice Address - Street 1:13298 LONG CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-5573
Practice Address - Country:US
Practice Address - Phone:904-994-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-17473103K00000X
FLAPRN9328054364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst