Healthcare Provider Details

I. General information

NPI: 1578105060
Provider Name (Legal Business Name): LISDNEY ESPLUGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12832 SW 50TH CT
MIRAMAR FL
33027-5808
US

IV. Provider business mailing address

12832 SW 50TH CT
MIRAMAR FL
33027-5808
US

V. Phone/Fax

Practice location:
  • Phone: 305-720-0015
  • Fax:
Mailing address:
  • Phone: 305-720-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: