MEDICARE: MRS. LISA H TOMLIN MSN, 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	363LF0000X	Family Nurse Practitioner	45590	KS
2	363LF0000X	Family Nurse Practitioner	759632	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073519260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA H TOMLIN MSN, FNP

Provider Business Mailing Address
First Line	:	3913 BELLA VISTA LOOP
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-8723
Country	:	US
Telephone Number	:	254-449-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4801
Country	:	US
Telephone Number	:	210-614-8612
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/14/2012

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