Provider Demographics
NPI:1841471570
Name:RITTER, LISA JOY (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JOY
Last Name:RITTER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5860 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3596
Mailing Address - Country:US
Mailing Address - Phone:520-742-7890
Mailing Address - Fax:520-742-7894
Practice Address - Street 1:4601 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7005
Practice Address - Country:US
Practice Address - Phone:520-433-8000
Practice Address - Fax:520-300-7356
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2020-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3778363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ283340Medicaid
AZZ137103Medicare PIN