Provider Demographics
NPI:1164122867
Name:MACHADO CORDOVA, LISBET (ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:LISBET
Middle Name:
Last Name:MACHADO CORDOVA
Suffix:
Gender:F
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 SW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5225
Mailing Address - Country:US
Mailing Address - Phone:786-238-4329
Mailing Address - Fax:305-455-9578
Practice Address - Street 1:8211 SW 13TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5225
Practice Address - Country:US
Practice Address - Phone:786-238-4329
Practice Address - Fax:305-455-9578
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner