Provider Demographics
NPI:1124277199
Name:FREEMAN-BAGNALL, LISA (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:FREEMAN-BAGNALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 SE 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-3642
Mailing Address - Country:US
Mailing Address - Phone:352-215-0149
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2106772163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse