Provider Demographics
NPI:1568190122
Name:CIBRIAN BARROSO, LISY (FNP)
Entity Type:Individual
Prefix:
First Name:LISY
Middle Name:
Last Name:CIBRIAN BARROSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISY
Other - Middle Name:
Other - Last Name:CIBRIAN BARROSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5181NW 4TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:786-439-8621
Mailing Address - Fax:
Practice Address - Street 1:5181NW 4TH TERRACE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:786-439-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily