Provider Demographics
NPI:1538552328
Name:HERRON, LISA HUDSON (ARNP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:HUDSON
Last Name:HERRON
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 1:14070 W PARSLEY DR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2351
Mailing Address - Country:US
Mailing Address - Phone:615-584-0537
Mailing Address - Fax:
Practice Address - Street 1:14070 W PARSLEY DR
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2351
Practice Address - Country:US
Practice Address - Phone:615-584-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 0000019388363L00000X
FLARNP 9396248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9396248OtherFLORIDA STATE LICENSE