Provider Demographics
NPI:1588732606
Name:PARADISE, LISABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:LISABETH
Middle Name:
Last Name:PARADISE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 S LEMAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3929
Mailing Address - Country:US
Mailing Address - Phone:970-495-8368
Mailing Address - Fax:970-495-7492
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:PVH PALLIATIVE CARE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-495-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK923363LF0000X
COAPN.0990692-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73789852Medicaid
AKNP7861Medicaid
AKNP7861Medicaid