Healthcare Provider Details

I. General information

NPI: 1033020052
Provider Name (Legal Business Name): LISET RAMOS APRN11045651
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8857 NW 109TH TER
HIALEAH FL
33018-4547
US

IV. Provider business mailing address

8857 NW 109TH TER
HIALEAH FL
33018-4547
US

V. Phone/Fax

Practice location:
  • Phone: 305-794-4218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: