Provider Demographics
NPI:1952102915
Name:MARIN PENA, LISGREILY FRANCISCA
Entity type:Individual
Prefix:
First Name:LISGREILY
Middle Name:FRANCISCA
Last Name:MARIN PENA
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 1:220 W 68TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5387
Mailing Address - Country:US
Mailing Address - Phone:786-603-4375
Mailing Address - Fax:
Practice Address - Street 1:220 W 68TH ST APT 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5387
Practice Address - Country:US
Practice Address - Phone:786-603-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038378363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care