Provider Demographics
NPI:1245252360
Name:BASILE, LISA (RNFA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BASILE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 PGA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2823
Mailing Address - Country:US
Mailing Address - Phone:561-694-7776
Mailing Address - Fax:561-776-8486
Practice Address - Street 1:3401 PGA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2823
Practice Address - Country:US
Practice Address - Phone:561-694-7776
Practice Address - Fax:561-776-8486
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1458162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse