Individual
LISA MARIE SERVICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15507 NW 67TH AVE, MIAMI LAKES, FL 33014-2108
(305) 821-8611
(305) 827-1753
Mailing address
900 S PINE ISLAND RD, PLANTATION, FL 33324-3920
(305) 821-8611
(305) 827-1753
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
9105791
FL
363AM0700X
Medical Physician Assistant
Primary
9105791
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007661300
—
FL
Enumeration date
03/29/2012
Last updated
08/16/2019
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