Provider Demographics
NPI:1770156788
Name:DEVINS, LISA LYN (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYN
Last Name:DEVINS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HIGH POINT CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4177
Mailing Address - Country:US
Mailing Address - Phone:321-506-6621
Mailing Address - Fax:
Practice Address - Street 1:640 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4177
Practice Address - Country:US
Practice Address - Phone:321-506-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLQ8A8S6M3202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology