Provider Demographics
NPI:1770335168
Name:GARRIDO SAMON, LISBET
Entity type:Individual
Prefix:
First Name:LISBET
Middle Name:
Last Name:GARRIDO SAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 DERBYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2214
Mailing Address - Country:US
Mailing Address - Phone:786-307-6283
Mailing Address - Fax:
Practice Address - Street 1:330 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4443
Practice Address - Country:US
Practice Address - Phone:888-348-7363
Practice Address - Fax:888-348-7363
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily