Provider Demographics
NPI:1699983296
Name:LEVENSON, LISA L (ARNP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:L
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:LEVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:11767 S DIXIE HWY # 146
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4438
Mailing Address - Country:US
Mailing Address - Phone:305-422-1008
Mailing Address - Fax:410-862-2938
Practice Address - Street 1:11767 S. DIXIE HIGHWAY #146
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3315
Practice Address - Country:US
Practice Address - Phone:305-422-1008
Practice Address - Fax:410-862-2938
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2573872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2573872OtherARNP