Provider Demographics
NPI:1801884333
Name:GARDNER, LISA HALL (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:HALL
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:NICHELLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:438 W BREVARD ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1004
Mailing Address - Country:US
Mailing Address - Phone:850-577-0045
Mailing Address - Fax:850-513-3277
Practice Address - Street 1:438 W BREVARD ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1004
Practice Address - Country:US
Practice Address - Phone:850-577-0045
Practice Address - Fax:850-513-3277
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2214092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ084ZMedicare PIN