Provider Demographics
NPI:1366420648
Name:LIZARRAGA DE GARZA, MARTHA (FNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LIZARRAGA DE GARZA
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:520-625-8116
Mailing Address - Fax:520-625-0224
Practice Address - Street 1:695 S PECAN TREE LN
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5114
Practice Address - Country:US
Practice Address - Phone:520-625-8116
Practice Address - Fax:520-625-0224
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN075113163W00000X
AZAP2140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF94071Medicare UPIN