Provider Demographics
NPI:1972399442
Name:SOBERG, LISA ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SOBERG
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:CHREPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1011 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3195
Mailing Address - Country:US
Mailing Address - Phone:732-859-6935
Mailing Address - Fax:
Practice Address - Street 1:100 HWY 36 STE 2K
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1453
Practice Address - Country:US
Practice Address - Phone:732-531-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15095700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily