Provider Demographics
NPI:1518970508
Name:ADAMCZYK, LISA (APN)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ADAMCZYK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:3339 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5361
Mailing Address - Country:US
Mailing Address - Phone:392-528-5512
Mailing Address - Fax:
Practice Address - Street 1:3339 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5361
Practice Address - Country:US
Practice Address - Phone:239-252-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL28475Medicare UPIN