Provider Demographics
NPI:1750533543
Name:GLISAN, LYDIA ANN (FNP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:GLISAN
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 1:601 UNIVERSITY DR
Mailing Address - Street 2:TEXAS STATE STUDENT HEALTH CENTER
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4685
Mailing Address - Country:US
Mailing Address - Phone:512-245-2161
Mailing Address - Fax:512-245-9288
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:TEXAS STATE STUDENT HEALTH CENTER
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4685
Practice Address - Country:US
Practice Address - Phone:512-245-2161
Practice Address - Fax:512-245-9288
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily