Jardine, Lisa M

Jardine, Lisa M is an sole proprietor health care provider with primary practice located at 450 E Central Ave , Winter Haven FL 33880-3050. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Jardine, Lisa M can be contacted via phone (863) 294-0670.

Contact Information

Primary practice address
450 E Central Ave Winter Haven FL 33880-3050
Phone: (863) 294-0670
Fax: (863) 298-3200
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME76581 Florida

Profile Details

NPI number 1881662153
LBN Legal business name Jardine, Lisa M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 10th, 2006
Last updated Jun 12th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881662153 NPPES
Florida Other 160044555 MEDICARE ID/RRM PIN
Florida MEDICAID 255262100 MEDICARE ID/RRM PIN

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