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General NPI Number Information
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NPI Number | 1801675673
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Entity Type | Individual
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Provider Name | LIDISLAY GONZALEZ FUENTES ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1030 W 47TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3317
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Country | US
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Telephone | 786-531-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 W 47TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3317
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Country | US
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Telephone | 786-531-8250
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F09230547
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11030508
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License Number State | FL
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