Provider Demographics
NPI:1164067641
Name:FUNTIEO, LESBYE ODETTE (APRN)
Entity Type:Individual
Prefix:
First Name:LESBYE
Middle Name:ODETTE
Last Name:FUNTIEO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7641
Mailing Address - Country:US
Mailing Address - Phone:305-587-0797
Mailing Address - Fax:
Practice Address - Street 1:730 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7641
Practice Address - Country:US
Practice Address - Phone:305-587-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily