Provider Demographics
NPI:1528581840
Name:MARRA, LISA (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARRA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BRADY
Other - Last Name:HAUKE MARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2839 E STATE ROAD 80
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4786
Mailing Address - Country:US
Mailing Address - Phone:239-898-0622
Mailing Address - Fax:
Practice Address - Street 1:3441 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5060
Practice Address - Country:US
Practice Address - Phone:772-221-4000
Practice Address - Fax:772-221-4041
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9210862207Q00000X
FLARNP9210862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine