Individual provider Active NPI

Lisa Manubens

  • Gerontology Nurse Practitioner
  • Windermere, FL
National Provider Identifier
1790591931
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN11036629 Issued in FL
Practice address
11114 Camden Park Dr
Windermere, FL 34786-5634
Phone
(727) 871-6161
NPI assigned
Dec 3, 2024
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN11036629 FL Primary

Addresses

Primary practice location

11114 Camden Park Dr
Windermere, FL 34786-5634

Mailing address

PO Box 537
Haines City, FL 33845-0537
Phone (727) 871-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241230001675 FL Practitioner - Nurse Practitioner 6901107275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mobile Physicians Team, LLCGroup PAC ID 0345585261, 5 clinicians

Practice addresses (Care Compare)

1225 Havendale Blvd NW
Winter Haven, FL 33881-1349
Phone (863) 298-6717

294 Patterson Rd
Suite B
Haines City, FL 33844-6251
Phone (407) 467-1036

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Physicians Team LLC Single Specialty CurrentSince Dec 2, 2024 Accepting new patients
Manubens Comprehensive Clinic LLC Single Specialty CurrentSince Dec 2, 2024 Accepting new patients
Physicians Housecall Team, LLC Single Specialty Past Accepting new patients

Locations

294 Patterson Rd
Ste B
Haines City, FL 33844
Phone (407) 467-1036

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJAFAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/FFJEDD/Endpoint/FFJEDD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1790591931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 537",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338450537",
            "telephone_number": "727-871-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11114 CAMDEN PARK DR",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347865634",
            "telephone_number": "727-871-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUBENS",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11036629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windermere, FL

Sources for this page

Verify at the official NPI Registry.