Provider Demographics
NPI:1477101558
Name:MARINO, LISBETH G (APRN)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:G
Last Name:MARINO
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 1:17211 NW 43RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4303
Mailing Address - Country:US
Mailing Address - Phone:786-566-1688
Mailing Address - Fax:
Practice Address - Street 1:17211 NW 43RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4303
Practice Address - Country:US
Practice Address - Phone:786-566-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003938363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner