MEDICARE: LISA TAYLOR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	225787	NC
2	363LF0000X	Family Nurse Practitioner	R235120	MD
3	390200000X	Student in an Organized Health Care Education/Training Program	225787	NC
4	363LF0000X	Family Nurse Practitioner	1076566	TX

General Provider Information

NPI Number	:	1033511738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA TAYLOR FNP

Provider Business Mailing Address
First Line	:	6915 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1822
Country	:	US
Telephone Number	:	210-341-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6915 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1822
Country	:	US
Telephone Number	:	210-341-1487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	06/20/2022

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