Provider Demographics
NPI:1447959366
Name:VILLALOBO CRESPO, LISSETTE (APRN)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:VILLALOBO CRESPO
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 1:4514 3RD STREET CIR W APT 524
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1528
Mailing Address - Country:US
Mailing Address - Phone:941-681-4400
Mailing Address - Fax:
Practice Address - Street 1:731 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6058
Practice Address - Country:US
Practice Address - Phone:941-681-4400
Practice Address - Fax:813-588-0701
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily