Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN2975062 | FL |
NPI | 1073669172 |
---|---|
Provider Name | Lisa Paulette Panish |
First Address | Tampa, FL 33634-2367 |
Second Address | Tampa, FL 33634-2367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S74989 | (02) | FL |