Provider Demographics
NPI:1700118692
Name:DENNING-TATE, LISA J (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:DENNING-TATE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:DENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:6400 W NEWBERRY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6604
Practice Address - Country:US
Practice Address - Phone:352-416-1082
Practice Address - Fax:352-373-6144
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1983962367500000X
FL1983962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001794100Medicaid