Provider Demographics
NPI:1932353406
Name:LISOWSKI, MONIQUE L (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:L
Last Name:LISOWSKI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:L
Other - Last Name:DANTZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:ATTN: LAKELAND CBOC CLINIC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:
Practice Address - Street 1:4231 SOUTH PIPKIN ROAD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811
Practice Address - Country:US
Practice Address - Phone:863-323-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4795133VN1201X
FLND 4795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management