Individual
LISA M BRAASCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CST/CSFA
Contact information
Practice address
200 SOUTHERN BAY DR, SAINT JOHNS, FL 32259-6275
(904) 287-1918
Mailing address
200 SOUTHERN BAY DR, SAINT JOHNS, FL 32259-6275
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
84898
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84898
NBSTSA
—
Enumeration date
11/02/2011
Last updated
11/02/2011
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