Healthcare Provider Details

I. General information

NPI: 1821897398
Provider Name (Legal Business Name): LISETTE VANESSA WINANS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PORT MALABAR BLVD NE STE 4
PALM BAY FL
32905-5153
US

IV. Provider business mailing address

PO BOX 361095
MELBOURNE FL
32936-1095
US

V. Phone/Fax

Practice location:
  • Phone: 321-844-7001
  • Fax: 321-622-6544
Mailing address:
  • Phone: 321-253-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9332416
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11039647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: