Provider Demographics
NPI:1598547713
Name:TOMLINSON, LISA WATKINS (NP, RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WATKINS
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11359 NEW ENGLAND PL
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7502
Mailing Address - Country:US
Mailing Address - Phone:510-499-9848
Mailing Address - Fax:
Practice Address - Street 1:12417 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2501
Practice Address - Country:US
Practice Address - Phone:916-727-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty