Provider Demographics
NPI:1881264869
Name:PLANCHER, LISETTE (NP-C-PA)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:PLANCHER
Suffix:
Gender:F
Credentials:NP-C-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 RACEWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5444
Mailing Address - Country:US
Mailing Address - Phone:954-668-0641
Mailing Address - Fax:
Practice Address - Street 1:2630 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-2550
Practice Address - Country:US
Practice Address - Phone:954-525-4900
Practice Address - Fax:954-396-3110
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11006864OtherLICENSE