Active NPI
Lisa M Braasch, CST/CSFA
- Surgical Technologist
- Saint Johns, FL
National Provider Identifier
1780960864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 84898
- Practice address
- 200 Southern Bay Dr
Saint Johns, FL 32259-6275 - Phone
- (904) 287-1918
- NPI assigned
- Nov 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 84898 | Primary |
Addresses
Primary practice location
200 Southern Bay Dr
Saint Johns, FL 32259-6275
Mailing address
200 Southern Bay Dr
Saint Johns, FL 32259-6275
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84898 | Other | NBSTSA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1780960864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 SOUTHERN BAY DR",
"city": "SAINT JOHNS",
"state": "FL",
"postal_code": "322596275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 SOUTHERN BAY DR",
"city": "SAINT JOHNS",
"state": "FL",
"postal_code": "322596275",
"telephone_number": "904-287-1918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAASCH",
"first_name": "LISA",
"middle_name": "M",
"credential": "CST/CSFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-02",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": null,
"license": "84898",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NBSTSA",
"identifier": "84898",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.