MEDICARE: LISA GAYLE WARREN NP

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	1033285	TX

General Provider Information

NPI Number	:	1881363018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GAYLE WARREN NP

Provider Business Mailing Address
First Line	:	700 W FM 78
Second Line	:	STE 203
City	:	CIBOLO
State	:	TX
Zip	:	78108-3553
Country	:	US
Telephone Number	:	210-688-8486
Fax Number	:	210-688-8487

Provider Business Practice Location Address
First Line	:	700 W FM 78
Second Line	:	STE 203
City	:	CIBOLO
State	:	TX
Zip	:	78108-3553
Country	:	US
Telephone Number	:	210-784-7993
Fax Number	:

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

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	05/09/2025

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