Provider Demographics
NPI:1710313747
Name:OLIVARES, LISA POMPA (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:POMPA
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-654-2064
Mailing Address - Fax:
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 475
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-654-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily