Provider Demographics
NPI:1982803995
Name:SWIFT, LISA ANNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:33053-1718
Mailing Address - Country:US
Mailing Address - Phone:706-754-8884
Mailing Address - Fax:
Practice Address - Street 1:1459 MONTREAL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6900
Practice Address - Country:US
Practice Address - Phone:770-491-2622
Practice Address - Fax:678-990-5847
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health