Provider Demographics
NPI:1285095307
Name:NERI-LIZCANO, ROCIO MARISOL (NP)
Entity type:Individual
Prefix:MRS
First Name:ROCIO
Middle Name:MARISOL
Last Name:NERI-LIZCANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROCIO
Other - Middle Name:MARISOL
Other - Last Name:NERI-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1306
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:210-334-2851
Practice Address - Street 1:730 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1306
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:210-334-2861
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130621363LG0600X, 363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX481901YKQQMedicare PIN