Provider Demographics
NPI:1790068435
Name:MARQUEZ, LISA L (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N. D. SALINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537
Mailing Address - Country:US
Mailing Address - Phone:956-464-2402
Mailing Address - Fax:956-464-3339
Practice Address - Street 1:307 N D SALINAS AVE
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2929
Practice Address - Country:US
Practice Address - Phone:956-464-2402
Practice Address - Fax:956-464-3339
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB139879Medicare PIN