MEDICARE: LYDIA PHAN TORRES ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	863763	NV
2	363LA2100X	Acute Care Nurse Practitioner	ARNP9312946	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023511151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA PHAN TORRES ARNP

Provider Business Mailing Address
First Line	:	19558 TIMBERBLUFF DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2588
Country	:	US
Telephone Number	:	772-333-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 MCDANIEL ST STE 140
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-6308
Country	:	US
Telephone Number	:	702-633-0207
Fax Number	:	702-633-5099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	07/06/2023

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