Provider Demographics
NPI:1902457914
Name:SWEETERS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SWEETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 OLD KINGS RD S STE 4
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4356
Mailing Address - Country:US
Mailing Address - Phone:386-302-5363
Mailing Address - Fax:
Practice Address - Street 1:99 OLD KINGS RD S STE 4
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4356
Practice Address - Country:US
Practice Address - Phone:386-302-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist