Provider Demographics
NPI:1043099369
Name:IZQUIERDO, LORRAINE DEE DALISAY (NP)
Entity Type:Individual
Prefix:
First Name:LORRAINE DEE
Middle Name:DALISAY
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3244
Mailing Address - Country:US
Mailing Address - Phone:954-251-2381
Mailing Address - Fax:
Practice Address - Street 1:5810 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3244
Practice Address - Country:US
Practice Address - Phone:954-251-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily