Provider Demographics
NPI:1356536932
Name:CLONTZ, LISA M (RNFA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1467
Mailing Address - Country:US
Mailing Address - Phone:407-322-7841
Mailing Address - Fax:407-322-1778
Practice Address - Street 1:819 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1467
Practice Address - Country:US
Practice Address - Phone:407-322-7841
Practice Address - Fax:407-322-1778
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 2740032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse