Provider Demographics
NPI:1689125718
Name:ESTES, LISSETTE (LPN)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 LOOKOUT TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1762
Mailing Address - Country:US
Mailing Address - Phone:850-363-5156
Mailing Address - Fax:
Practice Address - Street 1:3124 LOOKOUT TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-1762
Practice Address - Country:US
Practice Address - Phone:850-363-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5198522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse