Provider Demographics
NPI:1871729509
Name:IANNUZZI, LISA (APRN CRNA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:IANNUZZI
Suffix:
Gender:F
Credentials:APRN CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1628
Mailing Address - Country:US
Mailing Address - Phone:203-606-4149
Mailing Address - Fax:
Practice Address - Street 1:4001 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1628
Practice Address - Country:US
Practice Address - Phone:203-606-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4123367500000X
FL9323177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered