Provider Demographics
NPI:1043102510
Name:CRISTOBAL, CARMEN LIDYA (FNP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:LIDYA
Last Name:CRISTOBAL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 NORMANDY WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6733
Mailing Address - Country:US
Mailing Address - Phone:352-678-8825
Mailing Address - Fax:
Practice Address - Street 1:1605 NORMANDY WAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6733
Practice Address - Country:US
Practice Address - Phone:352-678-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07250451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine