Provider Demographics
NPI:1730514712
Name:LISA ANN GINAPP
Entity type:Organization
Organization Name:LISA ANN GINAPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GINAPP
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC,WCC,GNP-BC
Authorized Official - Phone:281-923-4315
Mailing Address - Street 1:1605 LANIER DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4716
Mailing Address - Country:US
Mailing Address - Phone:281-923-4315
Mailing Address - Fax:
Practice Address - Street 1:1125 HIGHWAY 3 N
Practice Address - Street 2:SUITE 100
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4048
Practice Address - Country:US
Practice Address - Phone:409-938-5050
Practice Address - Fax:409-938-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525674363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174351001Medicaid
TX174351001Medicaid
TX313618YV9KMedicare PIN