Healthcare Provider Details

I. General information

NPI: 1972045987
Provider Name (Legal Business Name): LIA GIANNOTTI STRATTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIA GIANNOTTI

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WESTLAKE DR STE 100
WEST LAKE HILLS TX
78746-5373
US

IV. Provider business mailing address

102 WESTLAKE DR
WEST LAKE HILLS TX
78746-5394
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-7779
  • Fax: 512-444-0977
Mailing address:
  • Phone: 512-327-7779
  • Fax: 512-444-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132492
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAP132492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: