Provider Demographics
NPI:1073559886
Name:ZAMBRANO, LISA KAY (RN, ANP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:ZAMBRANO
Suffix:
Gender:F
Credentials:RN, ANP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:10501 N. CENTRAL EXPWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2200
Practice Address - Country:US
Practice Address - Phone:214-360-1535
Practice Address - Fax:214-360-1534
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590294363L00000X
TX590524208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7071OtherBCBS
TX8N7071OtherBCBS