# LISA MARIE MANN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1902371149
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 11417 | GA | Yes |
| 363A00000X | Physician Assistant | 9111500 | FL | — |

## Other

- **Enumeration date:** 10/03/2018
- **Last updated:** 02/21/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11417 | GEORGIA PHYSICIAN ASSISTANT LICENSE NUMBER | GA |
| 01 | — | 9111500 | FLORIDA PHYSICIAN ASSISTANT LICENSE NUMBER | FL |