Provider Demographics
NPI:1982293668
Name:FREZEK, LISANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:FREZEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15293 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4716
Mailing Address - Country:US
Mailing Address - Phone:786-804-7409
Mailing Address - Fax:
Practice Address - Street 1:1140 W 50TH ST STE 301
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3411
Practice Address - Country:US
Practice Address - Phone:305-827-0208
Practice Address - Fax:305-827-0280
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily