Healthcare Provider Details

I. General information

NPI: 1134840911
Provider Name (Legal Business Name): LISHAI TIERRA CREAR APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 CHRIS GAUPP DR
GALLOWAY NJ
08205-4460
US

IV. Provider business mailing address

3600 ROUTE 66 FL 3
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-9900
  • Fax: 609-404-3653
Mailing address:
  • Phone: 732-807-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01364500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: