Provider Demographics
NPI:1639680721
Name:STILES, LISA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:STILES
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 1:12780 WATERFORD LAKES PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4501
Mailing Address - Country:US
Mailing Address - Phone:321-841-9514
Mailing Address - Fax:407-636-7864
Practice Address - Street 1:11600 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9215
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9291927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL128036700Medicaid