Provider Demographics
NPI:1649157017
Name:LISARDO, CRISTINA (NP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:LISARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 HAZELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1332
Mailing Address - Country:US
Mailing Address - Phone:954-696-6837
Mailing Address - Fax:
Practice Address - Street 1:670 HAZELHURST AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1332
Practice Address - Country:US
Practice Address - Phone:954-696-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner