Provider Demographics
NPI:1740412089
Name:MUSICIAN, LISA MARIE (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:MUSICIAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 QUICKWATER CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5669
Mailing Address - Country:US
Mailing Address - Phone:570-269-5924
Mailing Address - Fax:
Practice Address - Street 1:10967 QUICKWATER CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5669
Practice Address - Country:US
Practice Address - Phone:570-269-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered