Provider Demographics
NPI:1033231618
Name:MACDOWELL, LISA F (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:MACDOWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5239
Mailing Address - Country:US
Mailing Address - Phone:386-423-9161
Mailing Address - Fax:386-423-3094
Practice Address - Street 1:265 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5239
Practice Address - Country:US
Practice Address - Phone:386-423-9161
Practice Address - Fax:386-423-3094
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 16371363L00000X
FL9333900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07723800Medicaid