Provider Demographics
NPI:1285936377
Name:ISAACS, LISA MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:ISAACS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6700
Mailing Address - Fax:812-450-6710
Practice Address - Street 1:520 MARY ST STE 340
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1679
Practice Address - Country:US
Practice Address - Phone:812-450-6700
Practice Address - Fax:812-450-6710
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003460A363LF0000X, 363L00000X
KY3007272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201004950Medicaid
IN201004950Medicaid
INM40071318Medicare PIN