Provider Demographics
NPI:1558901579
Name:SERRANO, LYSSEEVETH
Entity Type:Individual
Prefix:
First Name:LYSSEEVETH
Middle Name:
Last Name:SERRANO
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 1:1031 SW JERICHO AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7216
Mailing Address - Country:US
Mailing Address - Phone:772-519-4053
Mailing Address - Fax:772-237-2590
Practice Address - Street 1:1031 SW JERICHO AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7216
Practice Address - Country:US
Practice Address - Phone:772-519-4053
Practice Address - Fax:772-237-2590
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion