Provider Demographics
NPI:1467142356
Name:WEBSTER, LISA SIMONE (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SIMONE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW 46TH CT APT 2212
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6288
Mailing Address - Country:US
Mailing Address - Phone:253-282-5465
Mailing Address - Fax:
Practice Address - Street 1:2540 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2681
Practice Address - Country:US
Practice Address - Phone:410-758-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153969363LF0000X
MDAC005576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily