# LISA HIESTAND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811360092
- **Authorized official:** MS. LISA MICHELLE HIESTAND ARNP-C (ARNP-C)
- **Authorized official phone:** (863) 844-1636

## Contact information

- **Practice address:** 5929 COLONY PLACE DR, LAKELAND, FL 33813-2872
- **Practice address phone:** (863) 844-1636
- **Mailing address:** 5929 COLONY PLACE DR, LAKELAND, FL 33813-2872
- **Mailing address phone:** (863) 844-1636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | 2011842 | FL | Yes |

## Other

- **Enumeration date:** 11/10/2015
- **Last updated:** 11/10/2015