| Doctor Name: | LISA CUNNINGHAM |
| NPI Number: | 1033534284 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ARNP9294868 |
| Business Practice Address: | 298 S Yonge St Ormond Beach, FL - 321746264 |
| Business Phone Number: | 3862747862 |
| Business Fax Number: | 3862747863 |
| Mailing Address: | 1260 East Pkwy, DELAND |
| State: | FL |
| Postal Code: | 327243358 |
| Phone Number: | 4074167776 |
| Fax Number: | |
| NPI Enumeration Date: | 02/25/2014 |
| NPI Last Update Date: | 02/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP9294868 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |