Provider Demographics
NPI:1710955810
Name:MURILLO-ARISTONDO, LISSETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:MURILLO-ARISTONDO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LISSETTE
Other - Middle Name:
Other - Last Name:MURILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:321-221-1057
Practice Address - Street 1:849 GREENWAY PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-9482
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:321-221-1057
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3078392363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304577300Medicaid
FLY1146VMedicare PIN
FLY1146YMedicare PIN
FLY1146WMedicare PIN
FL304577300Medicaid
FLY1146UMedicare PIN
FLY1146XMedicare PIN