Provider Demographics
NPI:1548798150
Name:BANUCHI, LIZETH JOANNA (APRN)
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:JOANNA
Last Name:BANUCHI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LIZETH
Other - Middle Name:
Other - Last Name:REGO CORTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1307 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6543
Mailing Address - Country:US
Mailing Address - Phone:352-368-2238
Mailing Address - Fax:352-368-5042
Practice Address - Street 1:1307 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6543
Practice Address - Country:US
Practice Address - Phone:352-368-2238
Practice Address - Fax:352-368-5042
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009674208M00000X, 363LF0000X, 208M00000X
TNAPN0000022625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist