Provider Demographics
NPI:1649354390
Name:TOBE, LISA SCOTT (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SCOTT
Last Name:TOBE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 E ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2367
Mailing Address - Country:US
Mailing Address - Phone:502-384-8679
Mailing Address - Fax:502-899-6981
Practice Address - Street 1:11801 E ARBOR DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2367
Practice Address - Country:US
Practice Address - Phone:502-384-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3396P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0613403Medicare ID - Type Unspecified