Active NPI 1205085321 Individual Practitioner Female Practitioner

Lisa Laura Wall , PA

Physician Assistant • Vero Beach, FL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Lisa Wall, PA is a certified Physician Assistant practicing in Vero Beach, FL. With approximately 26 years of clinical experience since completing medical education in 2000, Lisa Wall delivers high-quality medical care to the local community at 3755 7TH TER STE 101.

Lisa Wall is affiliated with Leavitt Medical Associates Of Florida Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3755 7th Ter Ste 101

Vero Beach, FL 329606531

Telephone 7725695056

Fax 7725625098

Associated Practice Facility / Clinic

🏢 Skin Cancer Center Of The Treasure Coast, Inc. Facility NPI 1073601183

Medicare Profile & Education

Medical School

Other

Graduation Year

2000

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Vero Beach, FL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

26 Yrs +15.6 yrs vs City Avg

City Avg: 10.4 Yrs

State Avg: 11.1 Yrs

Regional Practice Density

72 Specialists

Practicing in Vero Beach, FL (10376 Statewide)

Telehealth Adoption Rate

11.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

77.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Wall (26 Years) 26 Yrs

Vero Beach Specialty Average (10.4 Years) 10.4 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,924	342	$25.00	$5.55
99213 Established patient office or other outpatient visit, typically 15 minutes	1,328	914	$318.00	$78.06
17000 Destruction of skin growth	736	483	$245.00	$43.50
17110 Destruction of up to 14 skin growths	430	341	$420.00	$94.84
11102 Tangential biopsy of single skin lesion	427	333	$380.00	$74.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	239	183	$446.00	$109.95
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	136	129	$201.00	$48.52
11103 Biopsy of related skin growth, each additional growth	107	76	$189.00	$42.70
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	63	55	$1113.00	$259.75
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	58	46	$651.00	$141.26
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	55	55	$393.00	$96.61
10040 Acne surgery	36	35	$427.00	$99.37
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	35	31	$891.00	$104.75
96405 Administration of chemotherapy into growth, 1-7	29	15	$313.00	$60.13
17004 Destruction of precancer skin growth, 15 or more growths	28	23	$617.00	$142.80
J9190 Injection, fluorouracil, 500 mg	24	12	$6.33	$2.88
69100 Biopsy of ear	23	21	$355.00	$58.56
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	18	17	$634.00	$78.04
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	18	15	$899.83	$389.41
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	17	15	$551.00	$114.30
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	16	14	$4.00	$0.95
Q0112 All potassium hydroxide (koh) preparations	16	15	$14.63	$5.71
11900 Injection into skin growth, 1-7 growths	13	13	$207.00	$43.63
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$582.00	$144.53
10060 Simple or single drainage of skin abscess	12	11	$452.00	$104.13

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,358	388	$25.00	$5.76
99213 Established patient office or other outpatient visit, typically 15 minutes	1,389	933	$318.00	$79.67
17000 Destruction of skin growth	813	518	$245.00	$46.82
11102 Tangential biopsy of single skin lesion	445	361	$380.00	$79.14
17110 Destruction of up to 14 skin growths	438	359	$420.00	$97.84
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	316	227	$446.00	$112.62
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	145	131	$201.00	$49.87
11103 Biopsy of related skin growth, each additional growth	122	78	$189.00	$44.50
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	87	87	$393.00	$100.03
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	83	65	$651.00	$142.22
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	76	67	$1113.00	$268.44
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	38	34	$891.00	$108.83
10040 Acne surgery	37	37	$427.00	$101.63
17004 Destruction of precancer skin growth, 15 or more growths	28	22	$617.00	$150.20
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	24	$634.00	$76.68
Q0112 All potassium hydroxide (koh) preparations	23	21	$18.00	$5.71
10060 Simple or single drainage of skin abscess	20	16	$452.00	$111.28
69100 Biopsy of ear	20	20	$355.00	$60.21
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	18	13	$4.00	$1.10
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	18	17	$1175.00	$384.88
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	18	17	$551.00	$121.64
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$582.00	$147.88
99202 New patient office or other outpatient visit, typically 20 minutes	14	14	$258.00	$63.86
11900 Injection into skin growth, 1-7 growths	14	12	$207.00	$34.44
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	12	12	$702.00	$157.24

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,150	461	$19.00	$5.90
99213 Established patient office or other outpatient visit, typically 15 minutes	1,360	965	$117.00	$80.97
17000 Destruction of skin growth	920	582	$135.00	$46.70
11102 Tangential biopsy of single skin lesion	478	383	$182.01	$81.13
17110 Destruction of up to 14 skin growths	423	355	$191.00	$99.36
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	375	279	$178.00	$113.73
11103 Biopsy of related skin growth, each additional growth	157	115	$98.00	$45.95
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	147	131	$73.00	$50.80
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	85	72	$531.00	$270.15
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	78	61	$310.00	$148.29
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	66	66	$183.00	$101.27
17004 Destruction of precancer skin growth, 15 or more growths	53	40	$341.00	$150.93
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	50	45	$417.00	$110.48
10040 Acne surgery	38	36	$174.00	$102.79
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	34	22	$450.00	$389.41
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	27	22	$230.00	$127.45
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	23	21	$282.00	$78.44
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	22	22	$278.00	$151.06
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	21	11	$3.00	$1.12
Q0112 All potassium hydroxide (koh) preparations	20	15	$11.00	$5.78
11104 Punch biopsy, first skin growth	17	17	$228.00	$114.36
69100 Biopsy of ear	15	15	$183.00	$70.00
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	13	13	$338.00	$173.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,714	438	$19.00	$5.66
99213 Established patient office or other outpatient visit, typically 15 minutes	1,319	972	$117.00	$81.39
17000 Destruction of skin growth	859	580	$135.00	$45.82
17110 Destruction of up to 14 skin growths	443	380	$191.00	$99.07
11102 Tangential biopsy of single skin lesion	411	343	$182.00	$82.46
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	326	264	$178.00	$115.24
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	162	149	$73.00	$49.80
11103 Biopsy of related skin growth, each additional growth	151	93	$98.00	$47.18
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	97	97	$183.00	$100.80
17004 Destruction of precancer skin growth, 15 or more growths	62	50	$341.00	$147.74
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	61	52	$310.00	$147.78
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	53	51	$531.00	$276.42
10040 Acne surgery	51	50	$174.00	$104.11
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	34	33	$417.00	$111.44
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	33	33	$278.00	$150.75
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	30	15	$3.00	$1.27
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	18	14	$450.00	$388.54
11900 Injection into skin growth, 1-7 growths	17	14	$97.00	$37.05
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	16	14	$319.00	$158.46
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$125.00	$65.38
69100 Biopsy of ear	15	15	$183.00	$65.22
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	15	14	$230.00	$126.82
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	13	$282.00	$78.22
Q0112 All potassium hydroxide (koh) preparations	11	11	$11.00	$5.83
11104 Punch biopsy, first skin growth	11	11	$228.00	$116.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,385	274	$19.00	$5.25
99213 Established patient office or other outpatient visit, typically 15 minutes	964	699	$117.00	$67.06
17000 Destruction of skin growth	507	359	$135.00	$45.37
17110 Destruction of up to 14 skin growths	307	257	$191.00	$99.11
11102 Tangential biopsy of single skin lesion	240	208	$182.00	$78.93
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	107	101	$178.00	$97.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	92	78	$73.00	$40.36
11103 Biopsy of related skin growth, each additional growth	82	52	$98.00	$47.81
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	78	78	$183.00	$96.77
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	46	39	$310.00	$144.69
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	41	34	$531.00	$267.95
99202 New patient office or other outpatient visit, typically 20 minutes	39	39	$125.00	$67.64
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	18	$417.00	$111.23
10040 Acne surgery	22	21	$174.00	$78.24
17004 Destruction of precancer skin growth, 15 or more growths	17	17	$341.00	$141.38
Q0112 All potassium hydroxide (koh) preparations	15	13	$11.00	$5.81
69100 Biopsy of ear	13	13	$183.00	$74.65
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$282.00	$76.89
11104 Punch biopsy, first skin growth	13	13	$228.00	$112.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,589	292	$19.00	$5.12
99213 Established patient office or other outpatient visit, typically 15 minutes	1,072	733	$117.00	$65.26
17000 Destruction of skin growth	582	413	$135.00	$45.84
17110 Destruction of up to 14 skin growths	294	256	$191.00	$97.48
11102 Tangential biopsy of single skin lesion	283	244	$182.00	$77.98
99202 New patient office or other outpatient visit, typically 20 minutes	148	148	$125.00	$67.47
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	100	98	$178.00	$95.60
11103 Biopsy of related skin growth, each additional growth	98	58	$98.00	$47.16
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	76	71	$73.00	$39.62
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	52	44	$531.00	$267.12
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	27	$417.00	$111.41
10040 Acne surgery	28	28	$174.00	$88.80
17004 Destruction of precancer skin growth, 15 or more growths	25	23	$341.00	$135.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$183.00	$96.05
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	23	17	$310.00	$130.42
Q0112 All potassium hydroxide (koh) preparations	19	16	$11.00	$5.71
69100 Biopsy of ear	19	18	$183.00	$76.17
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	16	16	$230.00	$107.25
11104 Punch biopsy, first skin growth	15	15	$228.00	$110.07
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	14	14	$450.00	$391.55

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,378	226	$19.00	$4.79
99213 Established patient office or other outpatient visit, typically 15 minutes	483	358	$117.00	$64.10
17000 Destruction of skin growth	456	307	$135.00	$46.27
11100 Biopsy of single growth of skin and/or tissue	255	210	$177.00	$85.00
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	240	221	$178.00	$94.74
17110 Destruction of up to 14 skin growths	178	151	$191.00	$98.39
11101 Biopsy of each additional growth of skin and/or tissue	115	63	$99.00	$29.58
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	112	95	$73.00	$38.59
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	83	62	$531.00	$269.79
99202 New patient office or other outpatient visit, typically 20 minutes	77	77	$125.00	$66.21
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	55	41	$417.00	$111.36
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	37	37	$183.00	$95.85
17004 Destruction of precancer skin growth, 15 or more growths	26	23	$341.00	$129.56
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	16	16	$282.00	$79.13
10040 Acne surgery	16	16	$174.00	$86.28
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	15	11	$310.00	$131.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,223	305	$19.00	$5.11
17000 Destruction of skin growth	605	369	$135.00	$45.89
99213 Established patient office or other outpatient visit, typically 15 minutes	529	364	$117.00	$64.15
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	409	344	$178.00	$94.20
11100 Biopsy of single growth of skin and/or tissue	320	252	$177.00	$82.73
17110 Destruction of up to 14 skin growths	220	177	$191.00	$97.62
11101 Biopsy of each additional growth of skin and/or tissue	119	79	$99.00	$29.48
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	82	70	$531.00	$267.98
17004 Destruction of precancer skin growth, 15 or more growths	52	41	$341.00	$133.91
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	51	46	$417.00	$113.12
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	46	45	$73.00	$38.25
99202 New patient office or other outpatient visit, typically 20 minutes	45	45	$125.00	$65.40
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	44	44	$185.16	$95.44
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	25	21	$251.00	$66.51
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	20	17	$418.00	$207.05
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	20	16	$415.00	$355.01
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	19	17	$382.00	$102.38
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	19	15	$230.00	$117.62
10040 Acne surgery	16	15	$174.00	$80.21

Medical Specialties & State Licenses

CMS Verified: 2024-03-13

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant

NUCC Taxonomy Code: 363A00000X

State License NJ 25MP00107400

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

017124100 (FL)

Commercial Insurance / Payer ID Medicare Ptan

IM816Z (FL)

Hospital & Practice Group Affiliations

Leavitt Medical Associates Of Florida Inc

3755 7th Ter, Vero Beach, FL 329606528

Phone: 7725695056

Leavitt Medical Associates Of Florida Inc

1503 Buenos Aires Blvd, The Villages, FL 321596825

Phone: 3527532812

Leavitt Medical Associates Of Florida Inc

1905 Clint Moore Rd, Boca Raton, FL 334962659

Phone: 5612414474

Leavitt Medical Associates Of Florida Inc

484 Us Hwy 1 C, Sebastian, FL 329588454

Phone: 7726466100

Secondary Practice Locations

484 Us Highway 1 Ste C

Sebastian, FL 329588454

Phone: 7726466100

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Mary Collins

Nurse Practitioner - Adult Health

NPI 1588537583

Dr. Robert Loewinger , MD

Dermatology - MOHS-Micrographic Surgery

NPI 1750387403

Doctor of Medicine (M.D.)

Dr. Angela Wipf , MD

Dermatology - MOHS-Micrographic Surgery

NPI 1831752211

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events

📍

Updated Practice Location March 13, 2024

Registered at 3755 7TH TER STE 101, VERO BEACH, FL 329606531 (Tel: 7725695056)

👤

Provider Name / Credentials Updated March 13, 2024

Recorded as LISA WALL, PA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Physician Assistant (License #25MP00107400 in NJ)

✅

NPI Profile Active June 23, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location June 23, 2017

Registered at 484 US HIGHWAY 1 STE C, SEBASTIAN, FL 329588454 (Tel: 7726466100)

📍

Updated Business Mailing Address June 23, 2017

Registered at 151 SOUTHHALL LN STE 300, MAITLAND, FL 327517172 (Tel: (407) 875-2080)

👤

Provider Name / Credentials Updated June 23, 2017

Recorded as LISA WALL, P.A.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 23, 2017

Physician Assistant

✅

NPI Profile Active August 24, 2009

NPI status registered as active in NPPES database

📍

Updated Practice Location August 24, 2009

Registered at 111 WEST WATER STREET, TOMS RIVER, NJ 08753 (Tel: 7322444700)

📍

Updated Business Mailing Address August 24, 2009

Registered at P.O. BOX 4979, TOMS RIVER, NJ 08753 (Tel: 7322444700)

👤

Provider Name / Credentials Updated August 24, 2009

Recorded as LISA WALL, P.A.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 24, 2009

Physician Assistant (License #25MP00107400 in NJ)

🟢

Initial NPI Registration & Enumeration September 12, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205085321

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: September 12, 2008

Last Update: March 13, 2024

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

151 Southhall Ln Ste 300

Maitland, FL 327517172

Phone: 4078752080

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.