Individual
MRS. LISA ANN ROYSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2308 W 21ST ST, PANAMA CITY, FL 32405-2424
(850) 763-1442
Mailing address
2308 W 21ST ST, PANAMA CITY, FL 32405-2424
(850) 763-1442
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
673364696
—
FL
Enumeration date
08/13/2010
Last updated
08/13/2010
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