Individual
GLISET RESTREPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
Mailing address
PO BOX 2066, LECANTO, FL 34460-2066
(352) 527-6888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5991
SC
363AM0700X
Medical Physician Assistant
Primary
9110146
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023243500
—
FL
Enumeration date
01/12/2017
Last updated
10/16/2025
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