Provider Demographics
NPI:1669722203
Name:HEREDIA, LIZETH ALEJANDRA (FNP-C)
Entity type:Individual
Prefix:
First Name:LIZETH
Middle Name:ALEJANDRA
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 CYPRESS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7559
Mailing Address - Country:US
Mailing Address - Phone:407-483-5900
Mailing Address - Fax:407-483-5902
Practice Address - Street 1:1144 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7559
Practice Address - Country:US
Practice Address - Phone:407-483-5900
Practice Address - Fax:407-483-5902
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4608363L00000X
FL3078392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner