Provider Demographics
NPI:1255888640
Name:THOMAS, LISSA REGI (MSN, APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:REGI
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSN, APRN,FNP-C
Other - Prefix:
Other - First Name:LISSY
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,MSN,APRN,FNP-C
Mailing Address - Street 1:4516 VIA VENTURA
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3160
Mailing Address - Country:US
Mailing Address - Phone:972-693-1944
Mailing Address - Fax:
Practice Address - Street 1:4516 VIA VENTURA
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3160
Practice Address - Country:US
Practice Address - Phone:972-693-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily