Provider Demographics
NPI:1487263802
Name:HERNANDEZ CRUZ, LISANDRA (APRN)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:HERNANDEZ CRUZ
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 1:3661 S MIAMI AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4200
Mailing Address - Country:US
Mailing Address - Phone:305-856-1082
Mailing Address - Fax:305-459-1926
Practice Address - Street 1:3661 S MIAMI AVE STE 503
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4200
Practice Address - Country:US
Practice Address - Phone:305-856-1082
Practice Address - Fax:305-459-1926
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009544363L00000X, 363LP0808X
FLRN9444292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112145600Medicaid
FL115905200Medicaid