Provider Demographics
NPI:1881879815
Name:BASSETT-IPPOLITO, LISA RENEE (DC, APRN FNP-C)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:BASSETT-IPPOLITO
Suffix:
Gender:F
Credentials:DC, APRN FNP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:920 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6847
Mailing Address - Country:US
Mailing Address - Phone:561-747-7707
Mailing Address - Fax:561-748-5502
Practice Address - Street 1:920 W INDIANTOWN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6847
Practice Address - Country:US
Practice Address - Phone:561-747-7707
Practice Address - Fax:561-748-5502
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH9440111N00000X
FLAPRN11027579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor