Provider Demographics
NPI:1164025052
Name:MOLINA, LISETTE (APRN, FNP-BC, LAC)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:APRN, FNP-BC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9703 NW 5TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4010
Mailing Address - Country:US
Mailing Address - Phone:786-930-3328
Mailing Address - Fax:
Practice Address - Street 1:28 W FLAGLER ST STE 550
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1891
Practice Address - Country:US
Practice Address - Phone:786-292-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029781363LF0000X
FLAP4206171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist