Provider Demographics
NPI:1346489168
Name:COOK, LISA RENE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENE
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12865 POINTE DEL MAR WAY
Mailing Address - Street 2:#160
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-350-7546
Mailing Address - Fax:
Practice Address - Street 1:12865 POINTE DEL MAR WAY
Practice Address - Street 2:#160
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-350-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3276363LF0000X
CA19593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346489168OtherNPI