MEDICARE: MS. LISYS CAMACHO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	9180120	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053377846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISYS CAMACHO ARNP

Provider Business Mailing Address
First Line	:	1345 LINCOLN RD
Second Line	:	SUITE 505
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2242
Country	:	US
Telephone Number	:	305-527-2546
Fax Number	:	888-297-8960

Provider Business Practice Location Address
First Line	:	1345 LINCOLN RD
Second Line	:	SUITE 505
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2242
Country	:	US
Telephone Number	:	305-527-2546
Fax Number	:	888-297-8960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	03/18/2011

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