Provider Demographics
NPI:1407959398
Name:LEVINE, LISSETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 SW 53RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4024
Mailing Address - Country:US
Mailing Address - Phone:305-553-1904
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1096
Practice Address - Country:US
Practice Address - Phone:305-585-5858
Practice Address - Fax:305-325-0293
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1970412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP76393Medicare UPIN