Provider Demographics
NPI:1023511151
Name:TORRES, LYDIA PHAN (ARNP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:PHAN
Last Name:TORRES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19558 TIMBERBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2588
Mailing Address - Country:US
Mailing Address - Phone:772-333-6108
Mailing Address - Fax:
Practice Address - Street 1:2031 MCDANIEL ST STE 140
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6308
Practice Address - Country:US
Practice Address - Phone:702-633-0207
Practice Address - Fax:702-633-5099
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV863763363LA2100X
FLARNP9312946363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9312946OtherMEDICAL LICENSE