Provider Demographics
NPI:1982837811
Name:TALLA, LYZETE AKWI (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LYZETE
Middle Name:AKWI
Last Name:TALLA
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 E EVANS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2025
Mailing Address - Country:US
Mailing Address - Phone:210-290-9740
Mailing Address - Fax:210-291-9741
Practice Address - Street 1:5515 E. EVANS ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261
Practice Address - Country:US
Practice Address - Phone:210-290-9740
Practice Address - Fax:210-291-9741
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX782593163W00000X
TXAP137487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse