Provider Demographics
NPI:1730240326
Name:MOORE, LISA S (ARNP, DNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 LEGENDARY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5347
Mailing Address - Country:US
Mailing Address - Phone:850-424-7320
Mailing Address - Fax:
Practice Address - Street 1:4476 LEGENDARY DR STE 100
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5347
Practice Address - Country:US
Practice Address - Phone:850-424-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9166216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily