Provider Demographics
NPI:1568942571
Name:FITZGERALD, LISA ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELIZABETH
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 EWING HALSELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3707
Mailing Address - Country:US
Mailing Address - Phone:210-575-4837
Mailing Address - Fax:210-575-8480
Practice Address - Street 1:8201 EWING HALSELL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3707
Practice Address - Country:US
Practice Address - Phone:210-575-4837
Practice Address - Fax:210-575-8480
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138521363L00000X, 363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388606101Medicaid
TX388606102OtherCSHCN