Provider Demographics
NPI:1427105774
Name:SALT, LISA M (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SALT
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:4255 US HIGHWAY 1 S STE 10
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7000
Mailing Address - Country:US
Mailing Address - Phone:904-240-0565
Mailing Address - Fax:904-240-0471
Practice Address - Street 1:4255 US HIGHWAY 1 S STE 10
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7000
Practice Address - Country:US
Practice Address - Phone:904-240-0565
Practice Address - Fax:904-240-0471
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2025-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00440191OtherPALMETTO GBA RAILROAD MED
FLP00440191OtherPALMETTO GBA RAILROAD MED