Provider Demographics
NPI:1881907202
Name:ZIMMER, LISA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJAX - DEPT. OF SURGERY/TRAUMA
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-6631
Practice Address - Fax:904-244-4687
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2021142363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0025137-00Medicaid
GA883390578AMedicaid
GA883390578AMedicaid
FLDL732ZMedicare PIN