Provider Demographics
NPI:1346926565
Name:LEZCANO FUEGO, MARITZA (APRN)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:LEZCANO FUEGO
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 1:4572 BLUEBERRY WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4181
Mailing Address - Country:US
Mailing Address - Phone:786-384-2033
Mailing Address - Fax:
Practice Address - Street 1:4572 BLUEBERRY WOODS TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-4181
Practice Address - Country:US
Practice Address - Phone:786-384-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026624363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology