Provider Demographics
NPI:1740825025
Name:TORRES, TISDREY (APRN)
Entity type:Individual
Prefix:
First Name:TISDREY
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TISDREY
Other - Middle Name:
Other - Last Name:ROQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7038
Mailing Address - Country:US
Mailing Address - Phone:786-431-7870
Mailing Address - Fax:
Practice Address - Street 1:1192 E NEWPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7753
Practice Address - Country:US
Practice Address - Phone:305-243-5302
Practice Address - Fax:305-243-9161
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004359363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner