Provider Demographics
NPI:1114229945
Name:RANDALL, LISA MARIE (RN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:RN, ACNS-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:351 CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4528
Mailing Address - Country:US
Mailing Address - Phone:512-426-3627
Mailing Address - Fax:512-328-7488
Practice Address - Street 1:351 CYPRESS CREEK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4528
Practice Address - Country:US
Practice Address - Phone:512-426-3627
Practice Address - Fax:512-328-7488
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX710385364SA2200X
TXAP116205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314104601Medicaid
TX270956YMGJMedicare PIN