Provider Demographics
NPI:1083211726
Name:ZISSIS, STERGIOS (NP)
Entity type:Individual
Prefix:MR
First Name:STERGIOS
Middle Name:
Last Name:ZISSIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MACARTHUR BLVD # 105-164
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4216
Mailing Address - Country:US
Mailing Address - Phone:214-400-5548
Mailing Address - Fax:
Practice Address - Street 1:809 S MACARTHUR BLVD STE 400-2
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4260
Practice Address - Country:US
Practice Address - Phone:214-400-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064159363LA2100X
NM69453363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care