Blacklidge, Lisa Ann

Blacklidge, Lisa Ann is an individual health care provider with primary practice located at 206 2Nd St E , Bradenton FL 34208-1042. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Blacklidge, Lisa Ann can be contacted via phone (941) 746-5111.

Contact Information

Primary practice address
206 2Nd St E Bradenton FL 34208-1042
Phone: (941) 746-5111
Fax: (941) 745-7233
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9101122 Florida

Profile Details

NPI number 1275596728
LBN Legal business name Blacklidge, Lisa Ann
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2006
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275596728 NPPES
Florida MEDICAID 015120400
Florida Other 970020641

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