Provider Demographics
NPI:1033997325
Name:GOMEZ, LISA ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 N VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3302
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:119 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-6072
Practice Address - Country:US
Practice Address - Phone:830-422-3305
Practice Address - Fax:855-458-3317
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1136666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF08230919OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
TX762938OtherTEXAS BOARD OF NURSING