Provider Demographics
NPI:1376099549
Name:IBISATE, CITADEL GARCIA (APRN)
Entity Type:Individual
Prefix:
First Name:CITADEL
Middle Name:GARCIA
Last Name:IBISATE
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 1:2121 NICHOLASVILLE RD APT 211
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2503
Mailing Address - Country:US
Mailing Address - Phone:859-388-4273
Mailing Address - Fax:800-581-4201
Practice Address - Street 1:2121 NICHOLASVILLE RD APT 211
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2503
Practice Address - Country:US
Practice Address - Phone:859-388-4273
Practice Address - Fax:800-581-4201
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily