Provider Demographics
NPI:1649657792
Name:LIBERTI, DARLENE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:LIBERTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 ARBORETUM PL
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3719
Mailing Address - Country:US
Mailing Address - Phone:813-523-2765
Mailing Address - Fax:
Practice Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8317
Practice Address - Country:US
Practice Address - Phone:813-523-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9226566363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care