Healthcare Provider Details

I. General information

NPI: 1124732334
Provider Name (Legal Business Name): LIZETTE CISNEROS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PROVIDENCIA CT STE 3
BROWNSVILLE TX
78526-7453
US

IV. Provider business mailing address

10 PROVIDENCIA CT STE 3
BROWNSVILLE TX
78526-7453
US

V. Phone/Fax

Practice location:
  • Phone: 956-413-6162
  • Fax: 877-396-1196
Mailing address:
  • Phone: 956-413-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1106736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: