Provider Demographics
NPI:1710485552
Name:BORRERO HERNANDEZ, LILISBE
Entity type:Individual
Prefix:
First Name:LILISBE
Middle Name:
Last Name:BORRERO HERNANDEZ
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 1:2416 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4418
Mailing Address - Country:US
Mailing Address - Phone:305-698-5611
Mailing Address - Fax:305-614-4540
Practice Address - Street 1:2416 W 60TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4418
Practice Address - Country:US
Practice Address - Phone:305-698-5611
Practice Address - Fax:305-614-4540
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009924363LF0000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043635972Medicaid