Provider Demographics
NPI:1023401650
Name:GAUVIN, LISA JAYNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JAYNE
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:JAYNE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7815
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:844-358-4178
Practice Address - Street 1:3142 HORIZON RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7815
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:844-358-4178
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily