MEDICARE: MS. LIZA SUE ANN DE VENECIA LIGAYO FNP-BC

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	363LF0000X	Family Nurse Practitioner	842861	NV

General Provider Information

NPI Number	:	1619849346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIZA SUE ANN DE VENECIA LIGAYO FNP-BC

Provider Business Mailing Address
First Line	:	4515 S DURANGO DR APT 2088
Second Line	:	BLDG 22, APT 2088
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 S DURANGO DR
Second Line	:	BLDG 22, APT 2088
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6090
Country	:	US
Telephone Number	:	805-835-7107
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	10/15/2025

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