Provider Demographics
NPI:1982414702
Name:CAKO, LIDA (APRN)
Entity type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:CAKO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 501
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5170
Mailing Address - Country:US
Mailing Address - Phone:386-615-0900
Mailing Address - Fax:386-615-0902
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 501
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-615-0900
Practice Address - Fax:386-615-0902
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9497116163W00000X
FLAPRN11038863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse