MEDICARE: LISBEY VALLE 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	363LA2200X	Adult Health Nurse Practitioner	ARNP9269488	FL

General Provider Information

NPI Number	:	1588007223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISBEY VALLE ARNP

Provider Business Mailing Address
First Line	:	38503 CENTENNIAL RD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-1654
Country	:	US
Telephone Number	:	813-346-3500
Fax Number	:	813-346-3591

Provider Business Practice Location Address
First Line	:	38503 CENTENNIAL RD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-1654
Country	:	US
Telephone Number	:	813-346-3500
Fax Number	:	813-346-3591

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	02/27/2020

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