Mattingly, Lisa A

Mattingly, Lisa A is an individual health care provider with primary practice located at 1050 Loveland Blvd , Port Charlotte FL 33980-1813. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Mattingly, Lisa A can be contacted via phone (941) 764-0301.

Contact Information

Primary practice address
1050 Loveland Blvd Port Charlotte FL 33980-1813
Phone: (941) 764-0301
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME146476 Florida

Profile Details

NPI number 1104186907
LBN Legal business name Mattingly, Lisa A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2012
Last updated May 1st, 2026 - about 6 months 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 1104186907 NPPES
Oklahoma MEDICAID 200444630A
Oklahoma Other 430265YRHZ

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