Provider Demographics
NPI:1750265377
Name:FLOOD, LISA TINIQUA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:TINIQUA
Last Name:FLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 ALEXANDER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8228
Mailing Address - Country:US
Mailing Address - Phone:803-386-4007
Mailing Address - Fax:
Practice Address - Street 1:1504 LEESBURG RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2214
Practice Address - Country:US
Practice Address - Phone:803-262-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007202196172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver