Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Lisa Laura Wall, PA

Individual provider Physician Assistant · NPI 1205085321

Mrs. Lisa Laura Wall, PA is a Physician Assistant in Vero Beach, Florida. Qualified in 2000, 26 years ago. Practices with Leavitt Medical Associates of Florida Inc, a 195-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida and New Jersey.

Years since qualifying
26
Licensed in
FL, NJ
In the registry since
2008
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3755 7th Ter Ste 101
Vero Beach, FL 32960-6531
Phone: (772) 569-5056
Fax: (772) 562-5098
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 484 Us Highway 1 Ste C, Sebastian, FL 32958-8454 — (772) 646-6100

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (FL)
Physician Assistant Taxonomy 363A00000X · Licence 25MP00107400 (NJ)

Record details

NPI number1205085321
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedSeptember 12, 2008
Last updated in NPPESMarch 13, 2024
Certification dateMarch 13, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Leavitt Medical Associates Of Florida Inc — 195 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Vero Beach