Provider Demographics
NPI:1699861351
Name:LHERISSON, ELISABETH M (ARNP)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:M
Last Name:LHERISSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST
Mailing Address - Street 2:3RD FLOOR SUITE 306 ATTN N.AGUERO
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0173
Mailing Address - Fax:786-845-0176
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:305-575-3800
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2156872363L00000X
FLAPRN2156872363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720171895OtherNPI MIAMI-DADE COUNTY HEALTH DEPARTMENT
FL308106100Medicaid
FLBF884ZMedicare PIN