Basic Information
| Provider Information | |||||||||
| NPI: | 1083661169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORNER | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6417 3RD AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342092314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417924993 | ||||||||
| FaxNumber: | 9417952905 | ||||||||
| Practice Location | |||||||||
| Address1: | 6417 3RD AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342092314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417924993 | ||||||||
| FaxNumber: | 9417952905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 2861872 | FL | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LX0001X | 1609232 | FL | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.