MEDICARE: MS. LISA SANDE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10059	AZ
2	363LF0000X	Family Nurse Practitioner	AP10059	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP10059	OTHER	AZ	STATE LICENSE BOARD OF NURSING

General Provider Information

NPI Number	:	1396270625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA SANDE NP-C

Provider Business Mailing Address
First Line	:	3221 E WAVERLY ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3206
Country	:	US
Telephone Number	:	520-870-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 E RIVER RD STE 215
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-7645
Country	:	US
Telephone Number	:	520-220-8076
Fax Number	:	520-300-7156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/07/2026

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