Provider Demographics
NPI:1457888083
Name:EISERT, RHIANNA ELYSIA (LPN)
Entity Type:Individual
Prefix:
First Name:RHIANNA
Middle Name:ELYSIA
Last Name:EISERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 KISLING LOOP S
Mailing Address - Street 2:
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-1011
Mailing Address - Country:US
Mailing Address - Phone:619-737-7484
Mailing Address - Fax:
Practice Address - Street 1:5620 CHERRY ST STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6734
Practice Address - Country:US
Practice Address - Phone:850-249-3300
Practice Address - Fax:850-855-4045
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283357164X00000X
FLPN5225372164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse