Healthcare Provider Details

I. General information

NPI: 1609046721
Provider Name (Legal Business Name): LISA SANDERS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S ROME ST STE 101
GILBERT AZ
85297-7368
US

IV. Provider business mailing address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4172
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-3264
  • Fax: 480-722-2360
Mailing address:
  • Phone: 800-233-3264
  • Fax: 480-722-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP10525
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000013307
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: