Provider Demographics
NPI:1699453290
Name:PRIETO, LISA D (PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:PRIETO
Suffix:
Gender:F
Credentials:PMHNP
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Other - Credentials:
Mailing Address - Street 1:3206 DEERFIELD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1900
Mailing Address - Country:US
Mailing Address - Phone:352-727-3888
Mailing Address - Fax:904-264-2253
Practice Address - Street 1:1215 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4631
Practice Address - Country:US
Practice Address - Phone:352-727-3888
Practice Address - Fax:904-264-2253
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL05250025363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health