Provider Demographics
NPI:1972163954
Name:LOWE, LISA ANN (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LOWE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15985 PRESERVE MARKETPLACE BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5509
Mailing Address - Country:US
Mailing Address - Phone:727-416-2845
Mailing Address - Fax:
Practice Address - Street 1:2430 ESTANCIA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2607
Practice Address - Country:US
Practice Address - Phone:727-416-2845
Practice Address - Fax:727-205-5448
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002829363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11002829OtherFLDOH