Provider Demographics
NPI:1215521596
Name:EGGERS, LISA GAYE (NBC-HAS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
Last Name:EGGERS
Suffix:
Gender:F
Credentials:NBC-HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 SPYGLASS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-6682
Mailing Address - Country:US
Mailing Address - Phone:239-645-7476
Mailing Address - Fax:941-235-1904
Practice Address - Street 1:4265 TAMIAMI TRL UNIT F
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2149
Practice Address - Country:US
Practice Address - Phone:941-627-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5155237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist