Healthcare Provider Details

I. General information

NPI: 1063073716
Provider Name (Legal Business Name): LISETTE DUARTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22133 S DIXIE HWY
MIAMI FL
33170-2840
US

IV. Provider business mailing address

22133 S DIXIE HWY
MIAMI FL
33170-2840
US

V. Phone/Fax

Practice location:
  • Phone: 786-504-3119
  • Fax: 954-206-2835
Mailing address:
  • Phone: 786-504-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06190474
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11003084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: