Provider Demographics
NPI:1578203808
Name:GARZA, LYNDSAY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:MARIE
Last Name:GARZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNDSAY
Other - Middle Name:MARIE
Other - Last Name:BERAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3251 RIVER LODGE TRL S APT 521
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0835
Mailing Address - Country:US
Mailing Address - Phone:432-349-5156
Mailing Address - Fax:
Practice Address - Street 1:2419 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1506
Practice Address - Country:US
Practice Address - Phone:469-535-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant