Provider Demographics
NPI:1740256320
Name:MILLS, LISA G (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:G
Last Name:MILLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:G
Other - Last Name:SWIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:3501 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-5339
Practice Address - Fax:954-265-3464
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3032782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306398400Medicaid
FL42925YMedicare ID - Type Unspecified
FL42925ZMedicare ID - Type Unspecified