Provider Demographics
NPI:1497339329
Name:LIZARDO, CHRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LIZARDO
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 1:3258 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1212
Mailing Address - Country:US
Mailing Address - Phone:203-803-6171
Mailing Address - Fax:
Practice Address - Street 1:3258 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1212
Practice Address - Country:US
Practice Address - Phone:203-803-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112729163W00000X
CT9915363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse