Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 13068 | TN |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 9166765 | FL |
NPI | 1336327725 |
---|---|
Provider Name | Ms. Lisa M Pannell |
First Address | Oviedo, FL 32765-6966 |
Second Address | Orlando, FL 32804-7611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 13/03/2009 |