Provider Demographics
NPI:1770106734
Name:TELLERIA, LISETTE (APRN)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:TELLERIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISETTE
Other - Middle Name:
Other - Last Name:CORRALES ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5820 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2345
Mailing Address - Country:US
Mailing Address - Phone:305-753-3745
Mailing Address - Fax:
Practice Address - Street 1:5820 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2345
Practice Address - Country:US
Practice Address - Phone:305-753-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999611-NP363LG0600X
FLAPRN11006824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology