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General NPI Number Information
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NPI Number | 1699453290
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Entity Type | Individual
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Provider Name | LISA D PRIETO PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1215 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4631
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Country | US
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Telephone | 352-727-3888
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Fax | 904-264-2253
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Provider Business Mailing Address
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Address Line | 3206 DEERFIELD POINTE DR
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City | ORANGE PARK
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State | FL
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Zip | 32073-1900
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Country | US
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Telephone | 352-727-3888
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Fax | 904-264-2253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 05250025
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License Number State | FL
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