Doctor Name: | LISA MICHELLE MAZZAFERRO |
NPI Number: | 1174846380 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | ARNP9229045 |
Business Practice Address: | 7978 Cooper Creek Blvd Suite 105 University Park, FL - 342012141 |
Business Phone Number: | 9413598900 |
Business Fax Number: | 9413598990 |
Mailing Address: | 7978 Cooper Creek Blvd, Suite 105 UNIVERSITY PARK |
State: | FL |
Postal Code: | 342012141 |
Phone Number: | 9413598900 |
Fax Number: | 9413598990 |
NPI Enumeration Date: | 03/03/2010 |
NPI Last Update Date: | 12/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ARNP9229045 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |