Provider Demographics
NPI:1386971448
Name:SPEACH, LISA (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SPEACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 WOODRUFF RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3494
Mailing Address - Country:US
Mailing Address - Phone:864-312-6825
Mailing Address - Fax:864-312-6812
Practice Address - Street 1:355 WOODRUFF RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3494
Practice Address - Country:US
Practice Address - Phone:864-312-6825
Practice Address - Fax:864-312-6812
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPN3489OtherSC LICENSE