Healthcare Provider Details

I. General information

NPI: 1982293668
Provider Name (Legal Business Name): LISANDRA FREZEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST STE 301
HIALEAH FL
33012-3411
US

IV. Provider business mailing address

15293 SW 39TH TER
MIAMI FL
33185-4716
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-0208
  • Fax: 305-827-0280
Mailing address:
  • Phone: 786-804-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: