Basic Information
| Provider Information | |||||||||
| NPI: | 1073559886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMBRANO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN, ANP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CROCKER | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3600 GASTON AVE | ||||||||
| Address2: | STE 1205 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146928262 | ||||||||
| FaxNumber: | 2146964190 | ||||||||
| Practice Location | |||||||||
| Address1: | 10501 N. CENTRAL EXPWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752312200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143601535 | ||||||||
| FaxNumber: | 2143601534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 590294 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208800000X | 590524 | TX | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 8N7071 | 01 | TX | BCBS | OTHER |