Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | F05200224 | FL |
NPI | 1043838451 |
---|---|
Provider Name | Miss Lisa M Parker |
First Address | Sebastian, FL 32958-3735 |
Second Address | Sebastian, FL 32958-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2020 |
Last Update Date | 21/01/2022 |