Provider Demographics
NPI:1811917800
Name:MARBURY, LISA (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARBURY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1473
Mailing Address - Country:US
Mailing Address - Phone:731-925-1911
Mailing Address - Fax:731-925-8711
Practice Address - Street 1:895 CLIFTON RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1473
Practice Address - Country:US
Practice Address - Phone:731-925-1911
Practice Address - Fax:731-925-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN95297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929126Medicaid
TN3929126Medicaid
TN3929126Medicaid
TN19395Medicare UPIN