Service, Lisa Marie

Service, Lisa Marie is an individual health care provider with primary practice located at 15507 Nw 67Th Ave , Miami Lakes FL 33014-2108. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Community Health Worker, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Service, Lisa Marie can be contacted via phone (305) 821-8611.

Contact Information

Primary practice address
15507 Nw 67Th Ave Miami Lakes FL 33014-2108
Phone: (305) 821-8611
Fax: (305) 827-1753
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X 9105791 Florida
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 9105791 Florida

Profile Details

NPI number 1598031015
LBN Legal business name Service, Lisa Marie
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2012
Last updated Aug 16th, 2019 - about 7 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 1598031015 NPPES
Florida MEDICAID 007661300

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