Healthcare Provider Details

I. General information

NPI: 1578739785
Provider Name (Legal Business Name): LISA ANNETTE WARE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W
RANDOLPH AFB TX
78150-4800
US

IV. Provider business mailing address

838 LIGHTSTONE DR
SAN ANTONIO TX
78258-2310
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-2117
  • Fax: 210-652-7128
Mailing address:
  • Phone: 850-582-5601
  • Fax: 301-295-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN919081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: