Provider Demographics
NPI:1871746164
Name:BABLER, LISA LORA (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LORA
Last Name:BABLER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LORA
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5426 SUMMIT GLN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-1202
Mailing Address - Country:US
Mailing Address - Phone:320-522-4223
Mailing Address - Fax:
Practice Address - Street 1:5426 SUMMIT GLN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-1202
Practice Address - Country:US
Practice Address - Phone:320-522-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1218363A00000X
FLPA9118126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP35700Medicare UPIN