Provider Demographics
NPI:1538987920
Name:TIBBS, LISA BENTLEY (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BENTLEY
Last Name:TIBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BUCKBOARD ST
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1601
Mailing Address - Country:US
Mailing Address - Phone:469-831-7739
Mailing Address - Fax:
Practice Address - Street 1:617 BUCKBOARD ST
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1601
Practice Address - Country:US
Practice Address - Phone:469-831-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716636163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health