Provider Demographics
NPI:1508491788
Name:DIEGUEZ, LINDSEY (NP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:DIEGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11612 RIVER PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-4103
Mailing Address - Country:US
Mailing Address - Phone:610-291-9881
Mailing Address - Fax:
Practice Address - Street 1:10407 JOLLYVILLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5626
Practice Address - Country:US
Practice Address - Phone:512-334-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner