Provider Demographics
NPI:1336955053
Name:NAGLE, LISA J (FNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:NAGLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 MORNING STAR LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3736
Mailing Address - Country:US
Mailing Address - Phone:909-227-0587
Mailing Address - Fax:
Practice Address - Street 1:92 ASHDALE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-7311
Practice Address - Country:US
Practice Address - Phone:909-702-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily