Provider Demographics
NPI:1548721053
Name:SPEIGNER, LISA TAYLOR (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:TAYLOR
Last Name:SPEIGNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 SAINT PAUL RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-0704
Mailing Address - Country:US
Mailing Address - Phone:229-305-6960
Mailing Address - Fax:
Practice Address - Street 1:3178 MOUNT ZION CHURCH RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:GA
Practice Address - Zip Code:31779-5234
Practice Address - Country:US
Practice Address - Phone:229-294-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily