Provider Demographics
NPI:1174800700
Name:PIERCE, LISA JO (MHA, LPN, NHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MHA, LPN, NHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9707
Mailing Address - Country:US
Mailing Address - Phone:941-727-1243
Mailing Address - Fax:941-751-9039
Practice Address - Street 1:6120 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9707
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:941-751-9039
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
FLPN1174971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No133N00000XDietary & Nutritional Service ProvidersNutritionist