Provider Demographics
NPI:1417418278
Name:LIZZUL, RACQUEL
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:LIZZUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N UNIVERSITY DR STE 216
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8912
Mailing Address - Country:US
Mailing Address - Phone:954-688-9342
Mailing Address - Fax:754-229-6630
Practice Address - Street 1:1750 N UNIVERSITY DR STE 216
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8912
Practice Address - Country:US
Practice Address - Phone:954-688-9342
Practice Address - Fax:754-229-6630
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994835163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health