Provider Demographics
NPI:1063297083
Name:RESTREPO, LENIN FAISURY (FNP)
Entity type:Individual
Prefix:
First Name:LENIN
Middle Name:FAISURY
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KELLY CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7343
Mailing Address - Country:US
Mailing Address - Phone:407-638-0404
Mailing Address - Fax:
Practice Address - Street 1:112 KELLY CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7343
Practice Address - Country:US
Practice Address - Phone:407-638-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner