MEDICARE: LISA KAY ZAMBRANO RN, ANP-C

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	363L00000X	Nurse Practitioner	590294	TX
2	208800000X	Urology Physician	590524	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8N7071	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1073559886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAY ZAMBRANO RN, ANP-C

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	STE 1205
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-692-8262
Fax Number	:	214-696-4190

Provider Business Practice Location Address
First Line	:	10501 N. CENTRAL EXPWY
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75231-2200
Country	:	US
Telephone Number	:	214-360-1535
Fax Number	:	214-360-1534

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	02/01/2017

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