Provider Demographics
NPI:1043568652
Name:BABB, LISA JANELLE (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JANELLE
Last Name:BABB
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 1:720 W PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5214
Mailing Address - Country:US
Mailing Address - Phone:407-553-8587
Mailing Address - Fax:407-537-2063
Practice Address - Street 1:720 W PRINCETON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5214
Practice Address - Country:US
Practice Address - Phone:407-553-8587
Practice Address - Fax:407-537-2063
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9234317363LF0000X
FLAPRN9234317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily