Healthcare Provider Details

I. General information

NPI: 1003342734
Provider Name (Legal Business Name): LISA KAY ROBERTSON MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W 29TH ST
TUCSON AZ
85713-3353
US

IV. Provider business mailing address

7476 N CAMINO DE LA TIERRA
TUCSON AZ
85741-2123
US

V. Phone/Fax

Practice location:
  • Phone: 520-838-5600
  • Fax:
Mailing address:
  • Phone: 520-429-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberAP10054
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP10054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: