Provider Demographics
NPI:1679051676
Name:VANCE, LIZA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DAMONTE RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-2996
Mailing Address - Country:US
Mailing Address - Phone:775-852-9304
Mailing Address - Fax:
Practice Address - Street 1:3027 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1179
Practice Address - Country:US
Practice Address - Phone:719-776-3297
Practice Address - Fax:719-776-3297
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994618363LF0000X
NV811564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily