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Individual
LISA FELLIS
Active
Individual
LISA FELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4964
SC
363A00000X
Physician Assistant
PA9113743
FL
363AM0700X
Medical Physician Assistant
PA9113743
FL
Other
Enumeration date
01/06/2021
Last updated
07/17/2024
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