Female

Lisa M. Service PA-C

Medical Physician Assistant in Miami Lakes, FL(View on Map)

Full Name

Lisa Marie Service PA-C

NPI Number

1598031015

NPI Type

Individual Provider

Gender

Female

Enumeration Date

03/29/2012

Specialties

(Taxonomies)

Code

363AM0700X
172V00000X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

9105791

Contact
Information

Purpose

Mailing
Location

Address

900 S PINE ISLAND RD
15507 NW 67TH AVE

City

Plantation
Miami Lakes

State

FL
FL

Postal Code

33324-3920
33014-2108

Country

US
US

Telephone Number

(305) 821-8611
(305) 821-8611

Identifiers

Identifier

007661300

Identifier State

FL

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/16/2019

Provider Address

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