Provider Demographics
NPI:1851842405
Name:VIDAL, LISANDRA (DNP, ARNP, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:DNP, ARNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6408
Mailing Address - Country:US
Mailing Address - Phone:352-671-6471
Mailing Address - Fax:
Practice Address - Street 1:7960 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6408
Practice Address - Country:US
Practice Address - Phone:352-671-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9354868363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics